Graduation Application - Mater Dei Nakuru

SECTION A: PERSONAL INFORMATION

Title *

Surname *

First Names *

Date of Birth

Gender

Nationality

National ID / Passport No.

SECTION B: CONTACT INFORMATION

Postal Address

Postal Code

Town / City

Phone Number *

Alternate Phone

Email Address *

SECTION C: COURSE & ACADEMIC DETAILS

Course Title *

Admission Number *

Year of Enrollment

Mode of Study

Fees Cleared?

If No, explain

SECTION D: GRADUATION PACKAGE

Gown Hire

Photoshoot

Guest Tickets (Max 3)

SECTION E: PAYMENT (KES 5,000)

M-PESA: Paybill 222111 | Account: 2361269

Payment Method *

Transaction Code *

Amount Paid

Payment Date *

SECTION F: DECLARATION

I declare that the information provided is true. I understand that my name will be forwarded for graduation only upon full payment and clearance of all college dues.

I accept the declaration. *