Center for Executive and Entrepreneurial Development (CEED)
APPLICATION FORM
PLEASE PRINT CLEARLY
1. PERSONAL INFORMATION
Mr/Ms/Dr./Prof
____________________
____________________
Last Name
_____________________
_____________________
First Name
_______________________
___________________
Other Names
___________________
___________________
Street Address P.O. Box Number: __________________________________________________
City State: ______________________________Zip/Postal Country: _________________________
Daytime Phone Evening Phone Fax Number: _____________________________________________
Mobile Number: __________________________________________________
E-mail:__________________________________________________
Date of Birth ____________________________Place of Birth: _____________________________
Citizenship: ________________________ Marital Status: ________________________________
National ID No.______________________________
Female: ☐Male☐
Next of Kin or Guardian (Contact in case of emergency) ________________________________
Current Mailing Address (if different from above)________________________________
Are you a permanent Kenyan resident or citizen? YES ☐| NO ☐

If YES, provide a copy of this status together with the Application.______________________________
P. O. Box 14634- 00800 Nairobi, Kenya. Phone: 254-20-3606000, 3606 129.Cell: 0735661704, 0719513529
Center for Executive and Entrepreneurial Development (CEED)
2. ENROLLMENT INFORMATION
Please check the Programme you are enrolling for:
1. CEED Women Entrepreneurs Certificate Program ☐
2. Short Course ☐
3. Executive Diploma in Industrial Relation☐
Course
Fee (Kshs)
______________________ _____________________
______________________ _____________________
Duration
_______________________
___________________
Dates
_____________________
_____________________
3. WORK EXPERIENCE (CURRENT)
Name of Business __________________________________________________
Industry or Sector of the business __________________________________________________
How long has the business been in existence? __________________________________________________
Indicate your position in the business __________________________________________________
4. EDUCATION
PLEASE LIST ALL SCHOOLS AND COLLEGES ATTENDED IN THE FOLLOWING SECTION
NAME OF
SCHOOL/COLLEGE/
UNIVERSITY
City/country
Years (from – to)
Area of
Study
Name of
Certificate
5. HOW DID YOU LEARN ABOUT USIU-AFRICA?
School Teacher ☐Other (specify) ☐Friend ☐Newspaper ☐T.V. ☐Radio☐Mailing ☐College/High School Fair
☐USIU-Africa Website ☐
6. REGISTRATION REQUIREMENTS
1.
2.
3.
4.
Academic Testimonials
Professional certificates
A one page written statement explaining the reasons for enrolling in the programme
Passport size photograph
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Center for Executive and Entrepreneurial Development (CEED)
5. Non-refundable application fee of Kshs. 1000
*Note: No cash payments are accepted in the finance office
All payments should be made by bankers checks issued to United States International University (USIU-Africa),
or deposited into the accounts below; (then forward the deposit slip to the Finance Office at USIU-Africa).
7. TERMS AND CONDITIONS
By signing and returning the registration form, the authorising signatory on behalf of the stated
Company is subject to the following terms/conditions:
Company Trainee Substitutions: Trainee/Learner substitutions are welcome at any time. Please
notify Chandaria School of Business/Centre for Executive and Entrepreneurial Development (CEED)
in writing of any changes.
Trainee/Learner Cancellations: All trainee/learners cancellations must be received in writing and are
subject to the following conditions:
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
For any cancellations received 4 working days before the date of the training course, the full
fee will be payable to USIU and no refunds or credit vouchers will be given.
If a registered trainee/learner does not cancel and fails to attend the training course, this will be
treated as a cancellation and no refund or voucher will be issued.
Transfers: Transfer requests must be made in writing 10 days before the start of the course.
Cancellations and Postponement: In the event that USIU-CEED cancels a course,
trainee/learner payments at the date of cancellation will be credited to a future USIU-CEED
Short Course.
In the event that USIU-CEED postpones an event, trainee/learner payments at the
postponement date will be credited towards the rescheduled date. If the trainee/learner is
unable to attend the rescheduled event, the trainee/learner will receive a credit voucher
representing payments made towards a future USIU-CEED Short Course.
USIU-CEED shall assume no liability whatsoever in the event this course is cancelled,
rescheduled or postponed. For purposes of this clause, a fortuitous event shall include, but not
be limited to fire, labour strike, extreme weather or “any other sudden and unforeseen
circumstance.”
8. ATTESTATION
I hereby certify that the information given in this application is correct and complete to the best of my knowledge,
and hereby give my permission to the Admissions Office to obtain any verification deemed necessary to process my
application.
I further certify that I will arrange for the forwarding of official transcripts as requested in the instructions and that
such transcripts become the property of the university and will neither be forwarded to another institution nor
returned to me. I will include with this application my application fee and other documents as required in the
application instructions.
Signature: _________________________________ Date: _________________________________
IT IS MANDATORY TO SIGN YOUR APPLICATION FORM BEFORE RETURNING IT T
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Center for Executive and Entrepreneurial Development (CEED)
8.
USIU-AFRICA ACCOUNTS:
1. Commercial Bank of Africa Ltd.
Upper Hill Branch
KShs Account Number: 6438840014
Account Name: USIU-Africa or U.S. International University
SWIFT Code: CBAFKENX
2. Standard Chartered Bank
Kenyatta Avenue Branch, Nairobi
A/c No. 0104023439700
3. The Co-operative Bank of Kenya Ltd.
Co-op. Bank House Branch,
Haile Selassie Av, Nairobi
KShs Account No. 011/200/021341/00
4. MPESA Details
Example
M-pesa Pay bill
Business Number: 516900
Account Number : [CEED-Your Name]
Amount: KShs……………
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Center for Executive and Entrepreneurial Development (CEED)
SURVEY (OPTIONAL)
In order for us to provide you with your exact training and improve our course listing, please
answer the questions below:
1. List other course(s) you would like to take with us______________________________
2. Where would you most prefer to take our short courses from (tick those that apply)
a) At a hotel☐
b) Nairobi Central Business District☐
c) At your premise☐
d) Other (Indicate please) ☐______________________________
3. Please indicate your thoughts about our charges (tick one)
a) Good ☐ b) Moderate☐
c) Poor ☐
d) Other (List please)☐
______________________________
4. Please rate the duration/number of hours allocated to the course (Tick one)
a) Sufficient☐
b) Not sure☐ c) Not Sufficient☐ d) Other (Specify)☐
______________________________
Thank you for your participation
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