National Government - Constituencies Development Fundof Kigumo

National Government - Constituencies Development Fundof Kigumo

CDF BURSARY REF. NUMBER:……………………………………….

NATIONAL GOVERNMENT - CONSTITUENCIES DEVELOPMENT FUNDOF KIGUMO

P.O. BOX 10-10203, KIGUMO.

TEL: 0717 279 019 & 0734 279 679.

SECONDARY SCHOOL BURSARY APPLICATION FORM (SESBAF)

PART: 1 INSTRUCTION

  1. The constituency bursary scheme has limited available funds and is meant to support only the very needy cases. Persons who are able are not expected to apply.
  2. It is an offense to give false information.
  3. Applicants are advised to give certified copies of relevant support documents to enable accurate evaluation of their cases.
  4. Only original completed forms will be accepted. N.B. no photocopies
  5. All forms shall be returned at the Kigumo C.D.F office.
  6. Successful applicants will have the awarded bursary paid directly to university or college.
  7. Student photocopy of report form is mandatory.
  8. School fees statement or structure is mandatory.
  9. For new admission to form one (1) attached student KCPE results slip Mandatory
  10. Photocopy of admission letter.

PART A: GENERAL STUDENT’S DETAILS

YEAR OF BURSARY APPLICATION______CONSTITUENCY ______

WARD ______LOCATION ______

SUB LOCATION ______VILLAGE/ESTATE ______

PART B: STUDENT’S PERSONAL DETAILS

  1. FULL NAME

……………………………………………………………………………

LASTFIRSTMIDDLE

  1. Sex Male ( )Female ( )
  2. Name of school ………………………………………… Year of Admission
  3. Adm. No. Form/class Any disability:Yes No

Note: Provide documentary evidence for any physical disability

FOR THOSE JOINING FORM ONE (1)

a)Name of School admitted to:………………………………………………………..

b)School category National Provincial District

c)Former Primary school Head teacher remarks (Mandatory)

Student/pupil conduct: Excellent Very Good Good Fair Poor

I declare that to the best of my knowledge the above information is true or the applicant to attach a copy of certified school leaving certificate.

______

NAMESIGNATUREDATE & SCHOOL STAMP

FOR THOSE JOINING FORM ONE (1) OR CONTINUING IN FORM 2, 3 & 4

Totalfees Term ITotalfees Term IITotalfees Term III

KshsKshsKshs

Totalfees Outstanding fees (Confirmed by signing and Stamping by Head Teacher)

Kshs

PART B: FAMILY INFORMATION

1)Tick Approximately

Both parents Dead (Attach photocopy of Dead Parents Death Certificates)

One parent Dead (Attach photocopy of Dead Parent Death Certificate)

Both parents Alive (Attach photocopy of Parents Identity Card)

Single parent (Attach photocopy of Parent Identity Card)

Any disability (Letter explaining disability or other disadvantage circumstance from chief, religious leader, prominent reference).

PARTICULARS OF PARENTS/GUARDIANS

Father/Guardians Name ……………………………………………………………

Tel No………………………Identity Card No :…………………………( Attach copy).

Mother’s/Guardian’s Name ………………………………………………………..

Tel No …………………….Identity Card No :…………………………(Attach copy).

2. How many brothers and sisters do you have?

3. How many children does the guardian have?

4. How many are in Secondary schools?

6. How many are in Post-Secondary Institutions?

If both parents are not alive, who has been paying for your education? (Tick)

(for continuing students)

Guardiansponsor/well wishersany other (specify)

7. Have you ever benefitted from the Kigumo Constituency Bursary Fund?

YesNo

9. If yes state the amount in KesWhich Month Year

REFERENCE FROM CHIEF/SUB-CHIEF

Comment on the status of the family/parent

______

I certify that the information given above is correct.

Name ______Signature ______Date ______

(Official Stamp)

Position/Designation ______Tel. No…………………………………..

REFERENCE FROM RELIGIOUS LEADER

Comment on the family/parent status

______i certify that the information given above is correct.

Name ………………….………..…………Signature …………………….Date …………………….

Church/Religious organization …………………….……………………Tel. No ………….…….………

Official stamp ……………………………………………………………………………..

FOR OFFICIAL USE ONLY (By the Kigumo CDF secretariat)

a)Has the Bursary form been properly filled

b)Has the necessary documentary evidence been provided and attached

c)Has the student/parent/guardian provided the Name, ID card number and telephone for communication incase of award or further clarification?

d)Has the University/school/college stamped and sign the form

e)Has the fees structure been provided?

f)Has the form been booked in our bursary register and keyed into the computer?

Received by

……………………………….………………………..………………….

Name Sign Date

1

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