BN COUNTY GOVERNMENT OF BUNGOMA

MINISTRY OF EDUCATION & VOCATIONAL TRAINING

SUB COUNTY……………………………………………………WARD……………………………………….
NAME OF THE SCHOOL…………………………………………………TYPE OF SCHOOL (PUBLIC PRIVATE )
PUPILS DATA

S/N BOYS GIRLS TOTALS

1 PPI 1

2 PP2

TOTALS

DISABILITY DATA

BOYS GIRLS DESCRIPTION OF THE DISABILITIES

1 PPI

2 PP2
TEACHERS DATA

S/N NAME. P/F NO. ID TSCNO PHONE AGE

CURRENT
QUALIFICAT CONTRACT/
ION PERMANENT
1
2
3
4
5

FACILITIES DATA

S/N TYPE. . NO CONDITIONS/TYPE REMARKS

1 CLASS ROOMS
2 PLAY EQU1PMENT (BALLS,
SLIDES, SWINGS, OTHERS
3 PLAY GROUND
4 LEARNING
MATERIALS (TEXT BKS,
CHARTS, COUNTERS, OTHERS)
5 FURNITURE (TABLES CHAIRS,
STOOLS
6 CHALK BOARDS
7 WATERTANK
8 LATRINES
9 FIRST AID KITS
10 SICK BAY(S)

ANY OTHER RELEVANT

INFORMATION

TEACHER IN CHARGE………………………………………SIGN…………………..…H/TEACHER…………….…..………SIGN………………………..

SUBCOUNTY COORD………………………………………. SIGN……………………………………………….