STUDENT APPLICATION FOR SCHOLARSHIP PROGRAMME March 2021

KCPE Candidates
The Scholarship is merit based and is open to bright but economically disadvantaged young boys and girls
joining Form One at Secondary Schools in Kenya in July 2021.
WHO SHOULD COMPLETE THIS FORM?
• KCPE March 2021 candidates.
• Demonstrate financial need.
• Scored a minimum of 370 marks in the recent K.C.P.E.
• Student must be a Kenyan citizen
• Student must be admitted to a public secondary school

INSTRUCTIONS FOR FILLING OUT THE SCHOLARSHIP APPLICATION FORM

1. This application form should be completed IN FULL and submitted via email provided below only.
Incomplete application forms will not be processed.
2. Give factual, comprehensive and authentic information in the form.
3. Where documentary evidence is required and not provided, the form will be rejected.
4. Canvassing will lead to automatic disqualification.
5. This document is not in any way an agreement or commitment.
6. The selection of learners is totally dependent on excellent results obtained and the outcome of the
selection process.
7. Only shortlisted candidates will be contacted.

ADDITIONAL INFORMATION REQUIRED

•  A copy of the KCPE results slip MUST be attached.
•  A copy of the Secondary School admission Letter as and when received.
•  A copy of the applicant’s birth certificate MUST be attached.
•  A copy of the Primary school leaving certificate.
•  Attach evidence of being an orphan (death certificate, burial permit etc) or from a needy background.
•  Copies of parent’s/guardian’s ID where applicable.
•  Rough map of home.
Your applications should be forwarded ONLY via email to scholarship@heritage.co.ke and should reach us
by 30th June 2021.

NB: It is a criminal offence to provide false information in this application. Any person who does so may be
recommended for prosecution and the applicant will be automatically disqualified.

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PART I: PERSONAL DETAILS
Student’s Full Name: Date of birth:
P.O.Box: Town: Postal code:
County: Sub county: Ward:
Location: Sub location:

PRIMARY SCHOOL DETAILS

Primary school attended: K.C.P.E. Index No.:
County: Sub county: Ward:
P.O.Box: Town: Postal code:
Location: Sub location:

K.C.P.E. Results (Attach copy of results slip):

English Kiswahili Mathematics Science Social Studies TOTAL

When did you join the school? Have you repeated any class in the past (6-8)?

YES NO If Yes, which ones and when?

Have you been previously sponsored in primary school? YES NO

If Yes, state your sponsor and when this was:

SECONDARY SCHOOL DETAILS

Secondary school attended: (Attach copy of admission letter)

PART II: FAMILY DETAILS

Father’s name: ID No.: (Attach copy)
Source of income: Mobile No.:

Mother’s name: ID No.: (Attach copy)

Source of income: Mobile No.:

NB: Attach copy of death certificate /burial permit of a deceased parent

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GUARDIAN DETAILS (IF NOT LIVING WITH PARENTS)
Name of guardian: ID No.: (Attach copy)
Relationship: No. of other dependents:
Source of income: Mobile No.:

SIBLING INFORMATION
Name Age School/Employer Class/Tel No Marital Status

State why you are applying for the scholarship and describe briefly your disadvantage
or vulnerability:

I hereby declare that the information furnished above is true to the best of my knowledge and have not
falsified the information provided.

Pupil’s Signature: Date:

Parent/Guardian’s Signature: Date:

Witness
Name & ID: Relationship to the student:

Signature: Tel No.: Date:

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PART III: RECOMMENDATIONS/REFERENCES
Confirmation and recommendation by primary school headmaster:
I confirm that (Name of pupil) was a pupil in my school.
I also confirm that he/she scored marks and has been admitted to
school.

I recommend that this pupil be supported on the following grounds:

Family circumstances:

School performance:

Personality/conduct:

Name: Signature & school stamp: Date:

Mobile/Tel No.: Postal address:

Confirmation and recommendation by primary school headmaster:

I have read the information provided in this form and believe it to be truthful. Based on my knowledge of the
family and/or inquiries I have made, I make the following recommendation regarding the family circumstances
and conduct of this applicant:

Name: Signature & official stamp: Date:

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Mobile/Tel No.: Postal address:
County: Sub county: Ward:
Location: Sub location:

Recommendation by a local leader (Chief or Assistant Chief)

I have read the information provided in this form and believe it to be truthful. Based on my knowledge of the
family and/or inquiries I have made, I make the following recommendation regarding the family circumstances
and conduct of this applicant:

Name: Signature & official stamp: Date:

Mobile/Tel No.: Postal address:
County: Sub county: Ward:
Location: Sub location:

Recommendation by a spiritual leader (Priest, Pastor, Imam etc)

I have read the information provided in this form and believe it to be truthful. Based on my knowledge of the
family and/or inquiries I have made, I make the following recommendation regarding the family circumstances
and conduct of (name of applicant):

Name: Signature & official stamp: Date:

Mobile/Tel No.: Postal address:
County: Sub county: Ward:
Location: Sub location:

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