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Student counselling request form
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* Indicates required question
Email
*
Your email
Student information
Full Name
*
Your answer
Admission Number
*
Your answer
Campus
*
Main Campus, Ruaraka
Town Campus
Kitengela Campus
Western Campus, Kisumu
Mobile phone no.
*
Your answer
Are you currently in a crisis or emergency situation?
*
Yes
No
Not Sure
Confidentiality
Please note while counseling sessions are confidential we can not ensure confidentiality of information given online due to the nature of the Internet and email technology.
I have read and understood the confidentiality statement
*
Agree
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