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The Kenya Polytechnic University College Alumni Registration Form



Title:
1. Personal Details
Name of the Institution:
Kenya Polytechnic University College
Other (specify)
Name at Graduation:
Gender:
Year of Graduation:
Awarded:
Field:
2. Contact Details:
Postal Address:
Town/City:
Postal Code:
Email Address:
Physical Address:
Home Phone:
3. Alumni Programme Information
(Please check all that apply)
I am interested in becoming involved in KPUC's efforts to build an Alumni programme
I would attend programme meetings
I will help organize get tongethers and events
I will host an Alumni reception in my county
I am willing to be a mentor/provide career advice to current students
College Number:
Cell phone:
Current Place of Work:
Position/ Title: