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
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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