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)
I.
II.
III.
IV.
V.
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.
V.
VI.
VII.
NAME OF THE STUDENT_________________________________________
NAME OF INSTITUTION_________________________________________
ADRESS______________________________________________________
REG NO______________________________________________________
YEAR OF STUDY_______________________________________________
STUDENT CELLPHONE NO.______________________________________
OUTSTANDING FEES BALANCE______________________________________(ATTACH FEES
STRUCTURE)
1
A3. RESIDENCE
I.
II.
III.
IV.
V.
VI.
HOME DISTRICT____________________________________
DIVISION__________________________________________
WARD_____________________________________________
LOCATION__________________________________________
SUB-LOCATION_______________________________________
VILLAGE____________________________________________
A4 a) CONFIRMATION BY THE CHIEF/ASS.CHIEF
I.
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?______________________________________________________________
2
A6 NOTE
I.
II.
III.
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
I.
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.
3