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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)
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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
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NAME OF THE STUDENT_________________________________________
NAME OF INSTITUTION_________________________________________
ADRESS______________________________________________________
REG NO______________________________________________________
YEAR OF STUDY_______________________________________________
STUDENT CELLPHONE NO.______________________________________
OUTSTANDING FEES BALANCE______________________________________(ATTACH FEES
STRUCTURE)
A3. RESIDENCE
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HOME DISTRICT____________________________________
DIVISION__________________________________________
WARD_____________________________________________
LOCATION__________________________________________
SUB-LOCATION_______________________________________
VILLAGE____________________________________________
A4 a) CONFIRMATION BY THE CHIE/ASS.CHIEF
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NAME _________________________________________________
SIGN_________________________________________________
DATE_________________________________________________
OFFICIAL STAMP
A4 b) CONFIRMATION BY ELECTED MEMBER OF COUNTY ASSEMBLY
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NAME____________________________________________________
SIGN______________________________________________________
DATE_______________________________________________________
A5 FAMILY STATUS( TICK THE RELEVANT BOX)
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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
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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
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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.