APPLICATION FOR KANGEMA CONSTITUENCY BURSARY

UNIVERSITY / COLLEGES STUDENTS APPLICATION FORM

(Please read through the whole form before starting to fill). Attach Fees Structure,
students I.D., and National ID.
Students Name .................
Reg. No. Year of Registration ..
National ID.No. Tel: ..
Location: . Sub Location: .
Year of Study (Tick: 1st, 2nd, 3rd, 4th, Other: Date of Application: .....................
State whether Regular, Parallel or Private .................
Name of University
Course of Study Duration.........
Name of College ..
Course of Study: Duration....
Are you a beneficiary of University Loan / Bursary this year (YES/NO) Specify..
Amount awarded (If any) Kshs. ..
Amount applied for from CDF Kshs
Expected completion time: Month Year .
FAMILY BACKGROUND
Name of Parent / Guardian ...
Sub-Location .. Ass. Chiefs Name ..
Location Chiefs Name
Are both parents alive? .
OR One is alive (Specify) .
Any brothers / sisters at other institutions
NAME

INSTITUTION

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2
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9
10
What is the total amount that the University expects you to pay per year?.............................
(Attach University fees structure)

Attach schools identity card.

Students Occupation (if any)
STUDENT DECLARATION OR GUARDIAN
I certify that the information given above is true to the best of my knowledge.
Name:
Signature: .
Date:
ASSISTANT CHIEFS
I certify that the person named above is from my Sub-location and is a University student.
Comments:

Assistant Chiefs Name .

Signature ...
Official Stamp and Date
CDF SUB-LOCATION CHAIRMAN
I certify that the person named above is from my sub-location and is a University student.
Comments:

PMC Chairpersons Name:.

Signature..
Official Stamp and Date.
Date returned to PMC Chairperson.Sign.
NB:
1. False information will lead to disqualification and / or prosecution
2. Fully filled forms to be submitted to Sub Locational PMC Chairmans Offices.
FOR OFFICIAL USE ONLY
Amount applied .
Amount granted
Remarks

Signature of Officer in Charge:

Date: .