National Government Constituencies Development Fund

Kipipiri Constituency
P.O Box 25-20301,
Miharati.
NG-CDF KIPIPIRI
Email: cdfkipipiri@ngcdf.go.ke | Website: www.ngcdf.go.ke
Tel:0729963042

KIPIPIRI NG-CDF TERTIARY SCHOOLS BURSARY FORM

PART: 1 INSTRUCTION

1.Kindly provide information in legible CAPITAL letters

2.Attach fees structure and KUCCPS ADMISSION LETTERS(A MUST)
3.Attach copies of Parents/Guardian National ID
4.Student’s national ID copy/birth certificate
5.If Parent(s) is/are deceased, attach death certificate/Burial Permit(A MUST)
6.Submission of incomplete forms may lead to DISQUALIFICATION All forms shall be returned at the
Kipipiri C.D.F office Miharati
7. Successful applicants will have the awarded bursary paid directly to Secondary school
PART: 2 STUDENTS PERSONAL INFORMATION.

1. Full Name: Surname................................First Name..........................Other Name ................................

2. Gender: Male ( ) Female ( )
3. Status of the Applicant: Total Orphan [ ] Partial Orphan [ ] Needy [ ]
4. Who pays your fees: Father [ ] Mother [ ] Guardian [ ] Sponsored [ ] Self [ ]
5. Date of birth..............................REG NO ....................YEAR: ………..Mobile No............................
6. Name of Institution............................................Institution Address..................Year of Study…..............
8.University: Degree [ ] Diploma [ ] Certificate [ ]

9. College: KMTC [ ] Teachers college [ ] TTI’s [ ] Youth polytechnic [ ]

10. Special school [ ]

WARD ...........................LOCATION..............................VILLAGE/ESTATE..................................................

PART 4: FAMILY INFORMATION

1. Father’s name _________________________________ Occupation ______________________

ID No.____________ Phone Number_________________ Village________________________

2. Mother’s name _____________________________________Occupation ___________________

ID No._____________ Phone Number_________________ Village_______________________

3. Guardian’s name ____________________________________Occupation __________________

ID No.___________ Phone Number_________________ Village_______________________

Vision: Equitable social-economic development countrywide

ISO 9001:2008 Certified

 National Government Constituencies Development Fund
Kipipiri Constituency
P.O Box 25-20301,
Miharati.
NG-CDF KIPIPIRI
Email: cdfkipipiri@ngcdf.go.ke | Website: www.ngcdf.go.ke
Tel:0729963042

PART 5:FINANCIAL INFORMATION

Total Fees Able to Raise Other Grants Fee Balance

Kshs:………… Kshs:………… Kshs:……………… Kshs:…………..

PART 6: CHIEF/SUB CHIEF

Comment on the status of the family/parent
........................................................................................................................................................
........................................................................................................................................................
I declare that the information contained herein is correct to the best of my knowledge and belief.

I confirm that that the applicant is known to me and is a resident of my location.

Chief’s Name_____________________________Signature___________

Location _________________________ Date _____________________

PART 7:DECLARATION (Official Stamp)

Student’s Declaration
Why are you applying for this
bursary....................................................................................................................................................
Have you received/Applied for any financial support/bursary in this financial year from;

(a) County/Ward [ Yes] [No] (b) Presidential [ Yes] [No] (c) NGAAF (Women rep ) [ Yes] [No]

(d) Any other specify…………………………………………………………………………………………

PART 8: Parent’s Declaration

I declare that I have read this form/this information has been read to me and I have confirmed that the information
given here is true.

Parent’s/Guardian’s Name: ______________________________________________________________

Parent’s/Guardian’s signature: __________________________ Date: ____________________________

Vision: Equitable social-economic development countrywide

ISO 9001:2008 Certified

 National Government Constituencies Development Fund
Kipipiri Constituency
P.O Box 25-20301,
Miharati.
NG-CDF KIPIPIRI
Email: cdfkipipiri@ngcdf.go.ke | Website: www.ngcdf.go.ke
Tel:0729963042

PART 9:FOR OFFICIAL USE ONLY BY THE CONSTITUENCY BURSARY COMMITTEE.

SCORE......................................................

...............................Approved for Bursary ........................ Not approved for bursary: reasons

REASON: …………………………………
.......................................................
......................................................

Chairman: ........................................... Sign........................................... Date ...................

Secretary: ............................................ Sign........................................... Date ...................

Official Stamp...............................................................................................

Vision: Equitable social-economic development countrywide

ISO 9001:2008 Certified