Student Attachment Application Form
Please complete the form
AIC Kijabe Hospital
Date of Birth
Start with the most recent
Name of Training Institution
Institution Contact Details
Course you are taking
State your personal and professional goals for the next five years
Please write a brief (personal) history of your life
Name of the church you are a member of:
What is your present relationship with Jesus Christ?
To the best of my knowledge, the above information is accurate. Any falsification will constitute reason for rejection by the committee and or dismissal. I understand that I will need to sign a Standard of Conduct document and for attachments greater than one month, undergo an interview at my own expense BEFORE MY REPORTING DATE.
A copy of your responses will be emailed to the address you provided.
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