8/9/2019 College and University Bursary Application Form

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APPLICATION FOR KANGEMA CONSTITUENCY BURSARY

UNIVERSITY / COLLEGES STUDENTS APPLICATION FORM

(Please read thr!"h the #hle $r% &e$re start'" t $'ll)* Atta+h Fees Str!+t!re,

st!dets I*D*, ad Nat'al ID*

Students Name .................

Reg. No. Year of Registration ..

National ID.No. Tel: ..

Location: . Sub Location: .

Year of Study Tic!: "st# $nd# %rd# &t'# (t'er: Date of )**lication: .....................

State +'et'er Regular# ,arallel or ,ri-ate .................

Name of ni-ersity

/ourse of Study Duration.........

Name of /ollege ..

/ourse of Study: Duration....

)re you a beneficiary of ni-ersity Loan 0 1ursary t'is year Y2S0N(3 S*ecify..

)mount a+arded If any3 4s's. ..

)mount a**lied for from /D5 4s's

26*ected com*letion time: 7ont' Year .

FAMILY BACKGROUND

Name of ,arent 0 8uardian ...

Sub9Location .. )ss. /'iefs Name ..

Location /'iefs Name

)re bot' *arents ali-e .

(R (ne is ali-e S*ecify3 .

A- &rthers / s'sters at ther 'st't!t's

NAME INSTITUTION

"

$

%

&

;

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A'at is t'e total amount t'at t'e ni-ersity e6*ects you to *ay *er year.............................

Atta+h U'.ers't- $ees str!+t!re3

8/9/2019 College and University Bursary Application Form

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Atta+h s+hls 'det't- +ard*

Students (ccu*ation if any3

STUDENT DECLARATION OR GUARDIAN

I certify t'at t'e information gi-en abo-e is true to t'e best of my !no+ledge.

Name:

Signature: .

Date:

ASSISTANT C0IEFS

I certify t'at t'e *erson named abo-e is from my Sub9location and is a ni-ersity student.

/omments:

)ssistant /'iefs Name .

Signature ...

(fficial Stam* and Date

CDF SUB1LOCATION C0AIRMAN

I certify t'at t'e *erson named abo-e is from my sub9location and is a ni-ersity student.

/omments:

PMC Cha'r2erss Na%e:.

Signature..

(fficial Stam* and Date.

Date returned to ,7/ /'air*erson.Sign.

NB3

4* False '$r%at' #'ll lead t d's5!al'$'+at' ad / r 2rse+!t'

6* F!ll- $'lled $r%s t &e s!&%'tted t S!& L+at'al PMC Cha'r%as O$$'+es*

FOR OFFICIAL USE ONLY)mount a**lied .

)mount granted

Remar!s

S'"at!re $ O$$'+er ' Char"e3 77777777777777777777777

Date3 7777777777777777777777777777777777*