Registration

PERSONAL INFORMATION

HIGHER INSTITUTE OF APPLIED LEARNING (HIAL)

P.O Box 15509 – 00503, Mbagathi, Kenya
Mob. 0725 788 400 | Email: infohial@gmail.com | Website: www.hialinstitute.com

APPLICATION FORM

First Name

Middle Name

Last Name

Gender

Nationality

National ID / Passport No.

Date of Birth

Postal Address

Town / City

County

Mobile Number

Alternative Phone Number

Email Address

Institution Attended	Period	Certificate / Qualification Obtained

Course Applied For

Preferred Mode of Study

Full Name

Relationship

Mobile Number

Address