National Government Constituencies Development Fund
Bureti
P O Box 43
Litein, Kenya
NG-CDF BURETI CONSTITUENCY Email: www.ngcdf.go.ke
NG-CDF BURSARY APPLICATION FORM
FOR STUDENTS IN SECONDARY, COLLEGES AND UNIVERSITY
FY 2018/2019
(INSTRUCTIONS: Kindly provide your information in legible CAPITAL letters)
NB: Failure to fill in any PART or OMISSION of any required information will lead to AUTOMATIC
DISQUALIFICATION. All dully filled forms must be delivered to the NG-CDF office Bureti next to
Bureti sub-county headquarters ON OR BEFORE 21/12/2018.
PART A: TO BE FILLED BY THE STUDENT
I. PERSONAL, INSTITUTION AND OTHER DETAILS
Full Name of Applicant
(As it appears in ID/Official documents)
ID Number/Passport No.
(Where applicable)
Name of School/College/University
Campus/Branch
(For Tertiary Institution)
Class/Faculty/Department
Adm. No/Reg. No.
Age
Location
Sub-location
Mobile No/Tel No.
Fees arrears (Current)
Amount Applied for (Kshs)
II. FAMILY INFORMATION
Father’s Name …………………………………......... Occupation ……………………………..................
Mother’s Name ……………………………….......... Occupation ……………………………………........
Are both parents alive? Yes ( ) No ( ) who has been paying fees? …………………………….................
How many siblings do you have? …………………...How many are working………………...................
How many are in business? .....................................How many are in secondary schools? ........................
How many are in colleges? ..................................How many are in universities? ......................................
What is the estimated gross annual income for the family Kshs……………………………….................
Principal source of income……………Other sources…………………………………………..................
Amount spent in education fees……………………………………………………………….....................
III. VERIFICATION
Chief/Assistant Chief
a) Family Status (Tick where applicable)
Orphan ( ) Partial ( ) Single Parent ( ) Both parents alive but needy ( )
General observation on applicant’s family status ...................................................................................
b) Location ............................................. Sub-location ...................................................................
Official Stamp ................................................................. Date ................................................................
IV. KEY ATTACHMENTS TO THE FORM .
Applicants must attach copies of documents including the following:
1. Parent (s) Death Certificate or Burial Permit (For Orphans)
2. Current fees structure (Compulsory for all applicants) stamped
3. School/Institution Admission letters (Compulsory for College/University Students)
4. Student’s Transcript/Report Form.
5. Photocopy of National ID
6. Photocopy of Birth Certificate
7. Photocopy of the Secondary/College/University ID Card
8. Any other relevant supportive document
FOR OFFICIAL USE ONLY
OFFICIALS VETTING THE BURSARY
The form was duly filled and signed Yes ( ) No ( )
All supportive documents have been attached Yes ( ) No ( )
Approved................................................. Not Approved........................................................................................................
Reasons for disqualification....................................................................................................................................................
..................................................................................................................................................................................................
If approved Amount Award (Kshs)........................................................................................................................................
FOR OFFICIALS VETTING THE APPLICATION
NAME LOCATION/SUBLOCATION DESIGNATION SIGNATURE DATE
LOCATION BURSARY COMMITTEE REPRESENTATIVE
1.
2.
3.
NG-CDFC COMMITTEE REPRESENTATIVES
NG-CDFC
NG-CDFC
