Kiambu Town Constituency Development Fund P.O BOX 1767 - 00900 Kiambu Conditions
Kiambu Town Constituency Development Fund P.O BOX 1767 - 00900 Kiambu Conditions
UNIVERSITY/COLLEGES/SECONDARY BURSARY
APPLICATION FORM 2014/2015
STUDENTS RESIDENTIAL DETAILS
DISTRICT
DIVISION
LOCATIONSUBLOCATION.
WARD.VILLAGE/ESTATE
..
Last
First
Middle
2. Sex
Male( )
Female ( )
3. Date of Birth.Adm.
No..Class.
4. Day scholar ( )
Boarder ( )
THE BURSARY FORM SHOULD BE RETURNED TO THE KIAMBU TOWN C.D.F OFFICES ON OR
BEFORE 2ND MARCH 2015
1
5. Address.Telephone
.
6. Attach a photocopy of Institution ID (For Colleges & Universities)
INSTITUTION INFORMATION
1. Full Name of University / College/ Secondary school (Do not write in initials)
.
2. Institution Functional addressTelephone
number
Mothers /Guardians
name
Occupation /
Profession
.
2) How many brothers and sisters do you have?
THE BURSARY FORM SHOULD BE RETURNED TO THE KIAMBU TOWN C.D.F OFFICES ON OR
BEFORE 2ND MARCH 2015
2
Amount Awarded
No
If yes indicate Year awarded
9) Indicate assistance from any other sources: Yes
If yes indicate: Ministry of Education
Year awarded
No
County Council
Amount
Amount
paid
...
Amount requested from
CDF
(ATTACH AN APPROVED FEE STRUCTURE AND A CURRENT REPORT FORM)
CHIEF/SUBCHIEF/RELIGIOUS LEADER
Comment on the status of the
family/parents
THE BURSARY FORM SHOULD BE RETURNED TO THE KIAMBU TOWN C.D.F OFFICES ON OR
BEFORE 2ND MARCH 2015
3
.
I certify that the information given above is correct
Name..Signature
.Date.
Position/Designation
..
Address.Telephone
MOTHER
GUARDIAN/SPONSOR
GROSS
INCOME
*Gross Income: (This means income from salary, business and farming)
NAME OF
INSTITUTION
YEAR OF
STUDY/CL
ASS
TOTAL
FEES
FEES
PAID
OUTSTAND
ING
BALANCE
THE BURSARY FORM SHOULD BE RETURNED TO THE KIAMBU TOWN C.D.F OFFICES ON OR
BEFORE 2ND MARCH 2015
4
GRAND TOTAL
PART D: DECLARATION
1. STUDENTS DECLARATION
I declare that to the best of my knowledge the information given herein is true.
Students
signature..Date
..
3. UNIVERSITY/COLLEGE VERIFICATION
(a) For continuing students
Year of
study
Fair ( )
Poor ( )
I declare that the above named is a student in this University /College / Secondary
School.
Dean/Principals
Name
Signature.
.
Date and institutions
stamp
..
THE BURSARY FORM SHOULD BE RETURNED TO THE KIAMBU TOWN C.D.F OFFICES ON OR
BEFORE 2ND MARCH 2015
6
..
.
Bursary awarded Ksh.
Chairmans
Name.Signature.Date
Secretarys
Name.Signature.Date
..
Official Stamp
THE BURSARY FORM SHOULD BE RETURNED TO THE KIAMBU TOWN C.D.F OFFICES ON OR
BEFORE 2ND MARCH 2015
7