REPUBLIC OF KENYA, CGK/S5/NSEM/BURS/... COUNTY GOVERNMENT OF KISUMU DEPARTMENT OF EDUCATION, ICT AND HUMAN CAPACITY DEVELOPMENT. P.0. BOX 2738 ~40100 KISUMU. ‘APPLICATION FORIM FOR EDUCATION BURSARY FOR NEEDY STUDENTS SECTIONS D, € & F TO BE FILLED BY THE INSTITUTIONAL ADMINISTRATION D. INSTITUTION/SCHOOL DETAILS NAME OF INSTITUTION/SCHOOL (DAY / BOARDING|: ‘OFFICIAL INSTITUTION/SCHOOL CONTACT -anaeesPHYSICAL ADDRESS: NAME OF THE AUTHORIZED PERSONS AND SIGN: E.SCHOOV/INSTI DETALS NAME OF BANK: BRANCH: ACCOUNT NAME? sn cnnnsmen ACCOUNT NUMBER: :COMMENDATION sy 7} jOn/scHOOL [This should include the period the student has been absent within a term, reason for absenteeism, and if s/he isin noed of the echoe! foes} PRINCIPAL'S NAIVE & SIGNATURE: : STAMP & DATE: G. RECOMMENDATION BY THE AREA CHIEF/ASST. CHIEF: CCHIEF'S/ASST. CHIEF'S NAME & SIGNATURE: STAMP & DATE: FOR OFFICIAL Use: RECEIVED BY? inennnarnnesninininiitinsitininisniioe — DESIGNATION SIGNATURE: i os DATE & STAMP: ‘APPROVED BY BURSARY COMMITTEE: (YES/NO) .casccrvimonner AMOUNT APPROVED: KSHS. AMOUNT APPROVED IN WORDS: CHAIR WARD BURSARY COMMITTEE SIGNATURE: DATE WARD BURSARY COMMITTEE SCECRETARY sooo:uesvnennn en nmnsSIGNATURE: DATE Attach the following documents: 2. Current School/Institution Report Form 2. Schooi/Institution fees structure indicating the institution/school Bank, Branch and Account number. 3. Acopy of Institution’s/School’s Admission letter for new students. 4. Acopy of Death Certificate or Burial Permit for the parents/guardians 5. Acopy of Disability certificate in cases of disability 6. Acopy of KCSE/KCPE Result Sip NOTE: All applications MUST be processed by the Ward Bursary Committee,