Icpak Accounting & Finance Scholarship Application Form - 2016

ICPAK ACCOUNTING & FINANCE SCHOLARSHIP APPLICATION FORM - 2016

Scholarship is merit-based and is open to bright and needy young men and women joining publicuniversities only in Kenya. Applicants must have scored B+ and above to be eligible for the scholarship.

PROVIDING FALSE INFORMATION:

Providing false information may result in one or all of the following:

• Cancellation of the scholarship.
• Disqualification for award of any future scholarships offered by the Institute.

INSTRUCTIONS FOR FILLING OUT THE SCHOLARSHIP APPLICATION FORM

1. Read the application form carefully.
2. Fill in the application form using capital letters and leave space between words.
3. Give factual, comprehensive and authentic information in the form.
4. For family financial authentication, parents/guardian may be consulted.
5. Whenever in doubt when completing the form, consult the Marketing office at ICPAK.
6. Keep a copy of the filled –in original application for your records.
7. Ensure that you have attached all required documents by ticking the checklist.
8. Answer all questions. Those not applicable should be marked “N/A”.
9. This form should be handed back to the Chief Manager, Member Services, at Institute of Certified Public Accountants of Kenya (ICPAK), CPA Centre, 10th Floor, Thika Road, on or before 25th July, 2016.

APPLICATION FORM CHECK LIST

DescriptionTick the

Relevant:

1. Copy of KCSE and KCPE examination result slips
2. Copy of secondary school leaving certificate
3. University admission letter(must be a local public university in Kenya)
4. Reference letter from the head teacher of the former secondary school
5. A letter from your local chief or pastor supporting your application
6. Copies of previous scholarships attained
7. Copy of Guardian/parent latest pay slip
8. In case of demise of parent attach a copy of death certificate

SECTION A

Applicant Personal and Family Information:

1. Applicant’s Name:______
2. Gender: Male Female
3. Date of Birth:______Place of Birth: ______
4. Home County: ______
5. Permanent Address: ______
6. Telephone Number: ______
7. Total members the in family: Brothers_____ Sisters _____Others (Specify)______
8. Who is responsible for paying your school fees: ______

Family Information:

1. Father’s Name: ______
2. Father Status: Living Deceased If deceased please mention the date of demise.
3. Professional Status: Employed Peasant Farmer Unemployed If employed attach copy of latest pay slip.
4. Telephone Contact: ______
5. Mothers Name: ______
6. Mother Status: Living Deceased If deceased please mention the date of demise.
7. Professional Status: Employed Peasant Farmer Unemployed If employed attach copy of latest pay slip.
8. Telephone Contact: ______
9. Provide details of brothers and sisters in your family in the table below:

Any other supporting person or Guardian

1. Name: ______Relationship: ______
2. Address: ______
3. Telephone Number: ______
4. Occupation: ______

SECTION B

Applicant’s Education Record:

1. Name of the Primary & Secondary School(s) attended

1. Extra-Curricular activities undertaken in school:

1. Sports: ______
2. Clubs:______
3. Other social activities: ______

1. Mean grade (Marks) attained at class 8 KCPE & Form 4 KCSE results: ______
2. University & Courseadmitted to:

______

1. Names and contact details of three (3) referees as indicated below;

1. Additional Remarks:

In not more than 200 words please explain why you deserve this scholarship:

Signature of applicant: ______Date: ______

……………………………………………………………………………………………………………………………………………………

For Official Use Only:

Are the applicant documents in order: Yes No

Does the applicant qualify for award of scholarship: Yes No

______

Signature of Approving Person DepartmentDate

DEED OF AGREEMENT

Mr./Ms. ______Son/Daughter of______

P O Box ______Telephone: ______

Hereby called the Approved Student has been selected by ICPAK for the award of University Education scholarship for four years study at ______. The approved Student has accepted the award of the scholarship on the terms and conditions governing the scholarship award as below:

1. Scholarship will cover the following:
2. Tuition fees for four years
3. Basic hostel accommodation
4. Pocket money to cater for transport and daily upkeep. A minimum of Ksh. 1500 will be given for each week.
5. The continuous support under this scholarship program will be made subject to the complete adherence to all rules and regulations governing this program as well as satisfactory performance in tuition. It is the intention of ICPAK to continue supporting this program subject to availability of funds.
6. The Approved Student shall not change the indicated university without prior approval by ICPAK.
7. In case of selection by any other scholarship scheme, the approved student shall immediately inform ICPAK.
8. The scholarship will be discontinued in the following cases:
9. If the student fails to maintain class attendance
10. If the student is involved in malicious/undesirable activities
11. If the student is punished because of his involvement in violation of university rules, damage to university property, misbehavior with other students or staff or any other disciplinary action.
12. If information provided by student is found to be incorrect at any time during his/her study period.
13. If the student fails to maintain academic standards at the university.

The parties mentioned above have signed this deed in token of acceptance:

Signature of Student: ______Signature of Parent/Guardian: ______

Name: ______Name: ______

Date: ______Date: ______

Witnessed by:

Signature: ______Name: ______

Date: ______

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