CANOPY TRAINING INSTITUTE

Location: Thika, Garissa Road Telephone: 0707 132 271 / 0722 467 699 / 0722 471 760 / 0722 623 408 P.O BOX: 2831 - 0100, Email: info@ctithika.co.ke

SECTION A: PERSONAL DETAILS

First Name *

Last Name *

Date of Birth *

Gender *

ID / Passport No

KRA PIN

Nationality

County of Residence

Phone Number *

Email Address *

Address

SECTION B: NEXT OF KIN / EMERGENCY CONTACT

Full Name

Relationship

Phone Number

Address

SECTION C: ACADEMIC BACKGROUND

Level	School / Institution	Year Completed	Grade / Result
KCSE

SECTION D: COURSE DETAILS

Course Applied For *

Mode of Study

Preferred Intake

SECTION E: SUPPORT INFORMATION

Living with Disability?

If yes, specify

SECTION F: DOCUMENTS ATTACHED

Passport Photo

ID / Passport

KCSE Certificate