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REPUBLIC OF KENYA
NYANDARUA COUNTY GOVERNMENT
MINISTRY OF EDUCATION,YOUTH,CHILDREN
AFFAIRS,
CULTURE AND SOCIAL SERVICES
www.nyandarua.go.ke
Telephone:020266859
P.O BOX 701-20303
Fax:020266859
OL’KALOU
Email:[email protected], [email protected]
BURSARY APPLLICATION FORM
A1. FOR SPECIAL SCHOOLS/SECONDARY DAY/BOARDING SCHOOL( Tick applicable)
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VI.
VII.
VIII.
IX.
NAME OF THE STUDENT____________________________________________
NAME OF INSTITUTION___________________________________________
ADDRESS______________________________________________________
TEL.NO.OF THE
INSTITUTION___________________________________________________
FORM/CLASS___________________________________________________
ADM NO.______________________________________________________
YEAR_________________________________________________________
OUTSTANDING BALANCE___________________________________(ATTACH
SUPPORTING DOCUMENTS AND THE REPORT FORMS)
CONFIRMATION BY HEADTEACHER/PRINCIPLE
NAME______________________________SIGN___________DATE_______
SCHOOL RUBBER STAMP
A2. FOR COLLEGE/UNIVERSITY STUDENTS ONLY
I.
II.
III.
IV.
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VII.
NAME OF THE STUDENT_________________________________________
NAME OF INSTITUTION_________________________________________
ADRESS______________________________________________________
REG NO______________________________________________________
YEAR OF STUDY_______________________________________________
STUDENT CELLPHONE NO.______________________________________
OUTSTANDING FEES BALANCE______________________________________(ATTACH FEES
STRUCTURE)
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A3. RESIDENCE
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III.
IV.
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VI.
HOME DISTRICT____________________________________
DIVISION__________________________________________
WARD_____________________________________________
LOCATION__________________________________________
SUB-LOCATION_______________________________________
VILLAGE____________________________________________
A4 a) CONFIRMATION BY THE CHIEF/ASS.CHIEF
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II.
III.
NAME _________________________________________________
SIGN_________________________________________________
DATE_________________________________________________
OFFICIAL STAMP
A4 b) CONFIRMATION BY ELECTED MEMBER OF COUNTY ASSEMBLY
I.
II.
III.
NAME____________________________________________________
SIGN______________________________________________________
DATE_______________________________________________________
A5 FAMILY STATUS( TICK THE RELEVANT BOX)
I.
PARENTS
a)BOTH ALIVE
ALIVE
b) ONE ALIVE
c) BOTH NOT
a) NAME OF THE
PARENT/GURDIAN___________________________________________________
b) OCCUPATION_______________________________________________________
c) If both parents are not alive.i.e( total orohan) who has been paying you school
fees?______________________________________________________________
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A6 NOTE
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IV.
All relevant sections in this form MUST be filled and ensure that the information given is
correct
Wrong information will automatically disqualify the applicant
One should apply one form at a time in one ward ONLY
Supporting documents MUST be attached e.g.
a) Fees structurwe
b) Admission letter
c) Performance report/recent report form/transcript
d) School/ College/University ID card
e) Any other relevant documents
A7 FOR OFFICIAL USE ONLY BY BURSARY COMMITTEE
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II.
III.
BURSARY AWARD (kshs)__________________________________________________
REASON FOR THE AWARD________________________________________________
AUTHORIZED BY:
NAME_______________________________DESIGNATION_________________________
SIGN_________________________________DATE_______________________________
NB:
The money awarded will be sent to the respective education institution through a cheque.
Under no cicumstancen will fund be given out in cash.
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