; you are taking the first step process that will allow us to learn more about you, your achievements, id your goals as a potential Scholar of this Program. We encourage you to read the application guidelines before fling the form. ‘The application form is NOT FOR SALE and NO PAYMENT IS REQUIRED. Completed application and supporting documents should be sent to mefsp-applications@usiu.ac. ke by Monday, February 28, 2022, Our selection committee will eview all applications carefully and nominate finalists by the deadiine. All finalists will be interviewed either in person or virtually. Communications to the selected Scholars will be done by Thursday, June 30, 2022, Accompleted application should include the following: 1. Application letter stating the following: 8) Personal Background including family financial position. b) Why you chose USIU-Aftica. ©) Where you see yourself after graduation. 2. Copies of academic documents (Final High school certificates); ‘3. Recommendation from your high schoo! teacher, head teacher or sponsoring organization. The letter must be current, official, stamped and signed. 4. One recent Passport size photograph; 5. Acopy of your Birth certificate, National Identity Card or Passport and/or refugee travel document; 6. A copy of refugee identity document (where applicable). 7. Acopy of disability registration document/card (where applicable) Please note that we will NOT evaluate INCOMPLETE applications. ailed only ONGE. Duplicate applications or several emails ification of the applicant. Applications sent to another email y Monday, February 28, 2022. We strongly encourage earlier Slate the degree programm you are applying for Bachelor 24 Scuince in tnfarmation SyStons and Teck, Your pragram of choice must be among the 1 programs (Refer to the Call for Applications)8 } j ‘A; PERSONAL INFORMATION Please enter your name and all information as it appears on official dacuments such as an identification card, birth certificate, or Passport. ‘Namo; Last: ful raot_Deais missiohoqa other name: \ Imo ‘ pee Gonder FO war Nationality i: Oat OF) CE |9DE hy heim Yr Marital status; Single: Single Married: No of childran(t anyy ‘Ago at tho time of rae Cs eee Coma ers Sonth. Side oe County et ciizenstip Goth, Guden Country of residence at the time of application South: Sudan comynisen. La fra County g ia $ Place of residence atthe time of application: Urban fd Rural) Pen-urban CI Do youhavea passport? Yes No C) “Passport NoROOUD 4-8 YD “Wtyou have a passport, please atlach a copy ott this application. Passport Issued by (Country): SC Your Emal Address: Other Languages: 8: CATEGORY OF SCHOLARSHIP Please tick from the lst below’ the category of scholarship you are applying for Dyoung Women BYoung Men Refuges youth Diirtematy displaced Youth Douth with disabiity How did you learn about th orp Loecieved it theoughf-meil and redd it. Eecestoves indi rovce the obwing information: a Srehiges, 2. UNHCR Number a ee 4, ifearp, please name tho 5: Wiloysic leave giv dotata agenScholars Program For Internally Displaced Youth, Kindly provide the following: 1. Letter from relevant government authority stating reason and nature of displacement. For persons with disabiity, kindly provide the following information: |. Nature of disabiity: 2. Are you registered with any disability organizations? Yes] Nol) yes which one? 3. Please attach your disabiliy registration form/card }. Please indicate any special accommodation needs that you may require C. ACADEMIC INFORMATION Name of High/Secondary Schoo! DO D, Schopl — Gu Physical Address:(Location) — Gu Date of Graduation: 20.14 High’Secondary school exam system (eg, WAEC, GCE, KcSE, etc) _KCSE [SScsE Grade (s) Obtainea_8.5- 8 ‘Schoo! Type (mark all that apply): Government/Public C) IndependentPrigf Have you been admitted or attended any college/university? Yes) noD ae eee | Sponsor (if Qualification inetitution any) Obtained University College Others l If you were admitted and dropped out, or admitted and did not join please give reasons:- : {attach recammendatin late rom sponsor/ prot reewterviere pee ee ee Aopieant Name eats baa faut Umal proneiemal: Ubaadenis@ygnail «Com D. FAMILY INFORMATION (Contact person in case of emergency) Section 1: Parents or Guardians. Parent/Guardian #1 sumameUmol paincealex ‘Other Names: Salvatocic Soa cite re ae Relation toyou_LIncle — Occupation Seourihy guard Bieeeederee 2p.00ossp [Soup Ou Highest Level of Education Attained Diploma in Mechanical £agincering Mobile Phone: t+ HH 998 ISU F4F emai Country ot Residence South, Suctan price: Address uba — Gumbo Parent/Guardian #2 Mobile Pb Country ot Residence.Section 2: Siblings: Please list the Names, Level of Education, genders and ages of any brothers/ sisters yeu) have, even if they don live in your household. If you need more lines please attach a separate page at the end, Tec 1 Priary level nigel al | Uae Mary L Doll Primary level Applicant Name: Signature. E, SHORT ANSWER QUESTIONS. LEADERSHIP EXPERIENCE (300 words 0 anything more or less will not be evaluated) 1. Describe a previously held leadership position, activities, or experiences: (i.e. positions where you guided or led a group of people, a project, or a cause in which you were involved) I \ se cl as the Aulitart beadlny end Los le falafel se. Snferce cheol rules, Chaired the mectings f a Innaltor Weck of the cther prefect » [edt one ct Olterdance foe laine » decocat en oe nd £ carly to! scheot daily (Ledin the Church a6 the Seccctcy for liturgy tat para d si an Gpnec) foc cfd on pith clinics ch rebate aad Su Manes. Ay Of the hate petioa aad werle cis 48. What are you passionate about and how will your program of study contribute to your passion? (800 words maximum) iaposal te mare 4 ba cnec te ite Applicant Name a Phone/Email U4 Ubaaclnisti 6alotoy ty sll a Plustctaat te psoas alco alld a see Concepts catssi as ‘and Secvizea to Fight tis diteata. Describe your aspirations for social change and how you plan to achieve social change through your program of study (250 words mi imum) gag lig, Hise bate soe Las #¢ cheagasCullres raed | is i op f E fs | Applicant Name: Denis Ubaa [ isreok jo aOR