Attachment Form

Industrial Attachment Application Form

Applicants must upload required documents.
Application is absolutely FREE. No fee is required
Attachment fee is Ksh.3000 for Kenyan Citizens and 100 USD for foreign students for a maximum duration of three months. (Non-refundable).

Program Details

Program Name *

Level of Study *

Training Institution *

Year of Study

Personal Details

Contact Information

Next of Kin

Institution Supervisor Details

Required Documents

Scanned National ID *

Passport Size Photo *

Letter from Institution *

Hepatitis B Vaccination Card(optional)

Declaration

I declare that all information required has been disclosed and any material filled in support are true, correct and complete. I acknowledge that providing incorrect information or withholding relevant information may result in the Hospital withdrawing any engagement irrespective of the time the anomaly is established.

I agree to the above declaration.

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