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Kenya Association of Professional Counsellors: Application Form

The document is an application form for the Kenya Association of Professional Counsellors' School of Counselling Studies course. It requests personal details such as name, address, contact information, as well as academic and professional background. It also asks how applicants heard about the program and requires a declaration that the information provided is accurate. Upon completion, applicants are to return the form to the appropriate KAPC office based on location.

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Don Baraka Daniel
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68 views2 pages

Kenya Association of Professional Counsellors: Application Form

The document is an application form for the Kenya Association of Professional Counsellors' School of Counselling Studies course. It requests personal details such as name, address, contact information, as well as academic and professional background. It also asks how applicants heard about the program and requires a declaration that the information provided is accurate. Upon completion, applicants are to return the form to the appropriate KAPC office based on location.

Uploaded by

Don Baraka Daniel
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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Kenya Association of Professional Counsellors

(School of Counselling Studies)

APPLICATION FORM

PLEASE TYPE OR USE BLOCK CAPITALS IN BLACK OR BLUE INK

COURSE
Course title Branch:

PERSONAL DETAILS
Surname

First names
Gender
Date of birth (dd/mm/yyyy) Nationality
(M/F)
Permanent address

Postal code

Town Country
Correspondence address
(if different from above)
Postal code

Town Country

Email address

Phone number(s)

Emergency contact details

ACADEMIC BACKGROUND (start with most recent)


Qualification Award
From - to School/college/university Major Subject (with class/grade received
received) (Y/N)

PROFESSIONAL QUALIFICATIONS RELEVANT TO THE COURSE


Qualification Institute Year

1
Kenya Association of Professional Counsellors
(School of Counselling Studies)

EMPLOYMENT OR WORK EXPERIENCE (preferably related to the proposed course; start with most recent)
From - to Position Employer Nature of work

FINANCIAL SUPPORT FOR THE COURSE (please indicate)


Self sponsored Donor funded (indicate name of donor organization) Employer (indicate name of employer)

HOW DID YOU LEARN ABOUT KAPC (please tick)


Advertisement Brochure or flyer Career fair Employer Office visit

Poster Previous course Website Word of mouth Workshop

DECLARATION
I certify that the information given in this application is accurate and complete. I understand that the submission of inaccurate
information may be sufficient cause for refusal of admission or termination of registration.

Signature: Date (dd/mm/yyyy):

WHEN COMPLETED RETURN THIS FORM TO THE APPROPRIATE OFFICE


KAPC Nairobi KAPC Mombasa KAPC Kisumu KAPC Eldoret KAPC Kakamega
2nd Parklands Ave, Tom Mboya Str, At Kisumu Hospice, Rehema Complex, Canon Awaori rd
off Limuru Rd, Parklands after Mombasa Polytechnic off Kakamega Road Ronald Ngala Street Emission House
P.O. Box 55472 – 00200 P.O. Box 41356 – 80100 P.O. Box 2973 – 40100 P.O. Box 6955 P.O Box
Nairobi Mombasa Kisumu Eldoret Kakamega

Tel: +254 (0)20 3741051 Tel: +254 (0)41 2493050 Tel: +254 (0)57 2027071 Tel: +254 (0)53 2030682 Tel: +254 (0)714234343
Mobile: 0721296912, Mobile: 0725797888, Mobile: 0727232452, Mobile: 0712141272, 254 (0)722779190
0733761242 0735992036 0733770531 0734709332 Email: kapckk@gmail.com
Email: nairobi@kapc.or.ke Email: kpacmsa@gmail.com Email: Email: kapceld@gmail.com
kapcksm@gmail.com

FOR OFFICE USE ONLY


FT PT EvCl Wknd Starting date (dd/mm/yyyy): Duration:

Date received (dd/mm/yyyy) Acceptance (yes/reject/defer) Student number Db entry date (dd/mm/yyyy)

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