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Nyeri County Elimu Fund Application Form

This document is an application form for students seeking financial support from the Elimu Fund, a bursary program run by the County Government of Nyeri, Kenya. The application collects information about the student's profile, family circumstances, financial status, and academic performance. It requires declarations from the student, parents/guardians, area chief, and ward administrator to verify the details. The form will be scored and reviewed by a bursary award committee to determine if the student qualifies for financial support.

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Muji Gill
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599 views2 pages

Nyeri County Elimu Fund Application Form

This document is an application form for students seeking financial support from the Elimu Fund, a bursary program run by the County Government of Nyeri, Kenya. The application collects information about the student's profile, family circumstances, financial status, and academic performance. It requires declarations from the student, parents/guardians, area chief, and ward administrator to verify the details. The form will be scored and reviewed by a bursary award committee to determine if the student qualifies for financial support.

Uploaded by

Muji Gill
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

ELIMU FUND APPLICATION FORM

PART A (STUDENT’S PROFILE)

1. Full Name of student: ………………………………………………………………………


2. Sex: Male ( ) Female ( )
3. Sub county: ………………… Ward: ………………… Sub location: ……………………
4. Name of school/college/university: ………………………………………………………..
5. Admission /Registration Number: ………………………… Class/Year/Form: ……….….
6. Disability Status: Disabled ( ) Not Disabled ( )

PART B (FAMILY INFORMATION)


(Tick where applicable)

Both parents alive ( )


Single parent ( )
Full orphan (Both parents dead) ( )
Partial orphan (One parent dead) ( )

(Attach supporting documents e.g. death certificate, letter explaining disabilities or other
disadvantage/ circumstances from Chief/Assist Chief, Religious leader)

Have you ever benefited from the constituency Bursary or Elimu Fund or any other donor?
Yes ( ) No ( )

PART C (FAMILY FINANCIAL STATUS)


Gross income in the last 12 months (This means income from salary, business and farming)

Father Mother Guardian/Sponsor Total


Gross income

[COUNTY GOVERNMENT OF NYERI – ELIMU FUND APPLICATION FORM] Page 1


PART D (DECLARATIONS AND SIGNATURES)
Student’s Declaration
I do hereby declare that the information given herein is true to the best of my knowledge.

Student’s signature................................. Date.....................................

Parents/Guardians declaration
I declare that I have read this form/this form has been read to me and I hereby confirm that
the information given herein is true to the best of my knowledge.

Parents/Guardians Name: .......................................... Contact Mobile: ........................


Parents/Guardians Signature.................................... Date........................................

Area Chief/Assistant Chief’s/Religious leader’s declaration


I certify that the information given above is correct to my knowledge.

Name.............................................................................
Signature.............................. Date.....................................
Official stamp

Ward administrator’s declaration


I certify that the information given above is correct to my knowledge.

Name.............................................................................
Signature.............................. Date.....................................
Official stamp

(NOTE: STUDENT SHOULD ATTACH A COPY OF LATEST REPORT CARD AND


FEE STRUCTURE)

PART E: (FOR OFFICIAL USE ONLY)


To be used by the bursary award committee
Score ( )

Approved For Bursary ( ) Not approved for bursary ( )

Bursary awarded (Ksh.)………………………………………………………………

[COUNTY GOVERNMENT OF NYERI – ELIMU FUND APPLICATION FORM] Page 2

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