COUNTY GOVERNMENT OF NYANDARUA
NYANDARUA COUNTY GOVERNMENT
MINISTRY OF EDUCATION,YOUTH,CHILDREN AFFAIRS,
CULTURE AND SOCIAL SERVICES
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 REPPORT 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)
A3. RESIDENCE
I.
II.
III.
IV.
V.
VI.
HOME DISTRICT____________________________________
DIVISION__________________________________________
WARD_____________________________________________
LOCATION__________________________________________
SUB-LOCATION_______________________________________
VILLAGE____________________________________________
A4 a) CONFIRMATION BY THE CHIE/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
b) ONE ALIVE
c) BOTH NOT ALIVE
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?_______________________________________________________________________
A6 NOTE
I.
II.
III.
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
IV.
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.