Kenya Institute Of Surveying and Mapping P.O. Box 64005 – 00620, Nairobi, Kenya. Tel: +254 775 503 240 / +254 775 503 880 Email: info@kism.ac.ke Website: www.kism.ac.ke
ONLINE APPLICATION FORM
INSTRUCTIONS 1. Only candidates who meet all the minimum requirements stipulated in the advertisements should complete this form 2. The candidates are advised to fill all the parts of the form carefully 3. Only fully and duly completed forms will be considered 4. The application forms are to be accompanied with (i) passport size photograph (ii) copies of Academic and Birth Certificates, leaving certificate(s), and Identity Card. 5. All application forms are to be accompanied with a non-refundable fee of Kshs. 1,000 payable to: Kenya Institute of Surveying and Mapping, National Bank of Kenya. Harambee Avenue Branch Nairobi AC/No. 01060209240800			Photo Upload Max Photo Size: 100kb
First Choice Course		Second Choice Course
Department	Land Surveying Cartography Printing Photogrammetry & Remote Sensing	Department	Land Surveying Cartography Printing Photogrammetry & Remote Sensing
Selected Course	(Select) Diploma in Land Survey Certificate in Land Surveying	Selected Course	(Select) Diploma in Land Survey Certificate in Land Surveying
Applicant Details
Full Names Of Applicant
Sex	(Select) Male Female	Date Of Birth
ID Number		Place of Birth
County	(Select) Baringo Bomet Bungoma Busia Elgeyo Marakwet Embu Garissa Homa Bay Isiolo Kajiado Kakamega Kericho Kiambu Kilifi Kirinyaga Kisii Kisumu Kitui Kwale Laikipia Lamu Machakos Makueni Mandera Marsabit Meru Migori Mombasa Murang'a Nairobi Nakuru Nandi Narok Nyamira Nyandarua Nyeri Samburu Siaya Taita Taveta Tana River Tharaka-Nithi Trans-Nzoia Turkana Uasin Gishu Vihiga Wajir West Pokot	Division
Location		Sub Location
E - Mail		P.O. Box
Postal Code		Town
Mobile No.		Married	(Select) No Yes
Parent/Guardian Name		Guardian/Parent Cell No.
KCE /KCSE / "O" Level Examinations School Index No. Year MEAN SCORE ENG. MATH. PHY. GEO CHEM ---- A A- B+ B B- C+ C C- D+ D D- E ---- A A- B+ B B- C+ C C- D+ D D- E ---- A A- B+ B B- C+ C C- D+ D D- E ---- A A- B+ B B- C+ C C- D+ D D- E ---- A A- B+ B B- C+ C C- D+ D D- E ---- A A- B+ B B- C+ C C- D+ D D- E
Other Course (Select) I.G.C.S.E Artisan Certificate Craft Certificate Diploma First Degree Masters Degree PHD Overall Grade Institution Index No. Year No. Subject Name Grade 1. 2. 3. 4. 5. 6. 7.
1. Present Occupation (if any) 2. Previous Occupation (if any) 3. Do you suffer from any physical impairment? No Yes Details 4. Have you received any medical treatment for any serious disease or injury? No Yes Details
Application Fee Payment
Banking Slip No.
I declare that the information I have given herein is correct to the best of my knowledge			No Yes