Ministry of Labour and Social Protection

Department of Children’s Services

APPLICATION FORM FOR SECONDARY SCHOOL BURSARY (REVISED 2018)
A. GEOGRAPHICAL
LOCATION County: Constituency:
Sub-County: Location:
Sub-Location: Village:
Nearest Primary VYY
Nearest Church / Mosque

B. THE CHILD'S INFORMATION

Name: (Surname) (Other Names)
Date of birth: / / Sex: M /F . Is the child in school? Yes / No

If YES, state: Name of School:

Class: _________________Adm No. _____________
If NO, give reasons.

Name of Primary School attended

[Attach a copy of the KCPE Result Slip.]

C. FAMILY DETAILS
SIBLINGS OF THE CHILD
No Names Age Occupation Education * Other Remarks **
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
* - Highest level of education attained* * - May include marital status

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 D. ORPHANHOOD
Name of Father:

Is the Father alive? Yes / No Phone No.:

Name of Mother:

Is the Mother alive? Yes / No Phone No.:

Name of the Guardian(s): Phone No.:

What is the relationship of the child to the Guardian?

Does the child live in the same household as the Parent(s) or the Guardian?
Yes / No

Does the child receive any other similar support? Yes / No

If YES, state the source(s) of support.
Type of support given:
[Provide burial permit(s) / death certificate(s) where applicable.]

E. VULNERABILITY
Does the Father (if alive) suffer from any chronic illness? Yes / No

If YES, state the name of the illness.

Does the Mother (if alive) suffer from any chronic illness? Yes / No

If YES, state the name of the illness.

Does the father suffer from disability? Yes / No

If YES, state the form of disability.

Does the mother suffer from disability? Yes / No

If YES, state the form of disability.

F. POVERTY
If the Father is alive, what is his occupation?

Is he on pension? Yes / No

If the Mother is alive, what is her occupation?

Is she on pension? Yes / No

Occupation of the Guardian:

What is the current School Fees Structure?

What's the child's present Fees Balance?
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 G. DETAILS OF THE SCHOOL
Name of School
Name of School Principal
Geographical Details of the School
County: Constituency:
Sub-County: Location:
Sub-Location: Village:

Contacts
Phone No(s): Email Address:

Postal Address:

School Categorization
Type of school: Private / Public [Tick One]

School category: National / County / Sub-County [Tick One]

Enrolled In: Day School / Boarding School / Special School [Tick One]

School’s Bank Account Details

Bank: Branch:

Account Number:

H. RECOMMENDATIONS
i. Recommendation by the School Principal:
[This should include: the period the student has been absent within the term; reason(s) for absenteeism; and if s/he is in need of
the bursary.]
………………………………………………………………………………………………
………………………………………………………………………………………………
………………………………………………………………………………………………
Principal’s Name & Signature Date & Stamp:

ii. Recommendation by the Area Chief/ Assistant Chief:

………………………………………………………………………………………………
………………………………………………………………………………………………
………………………………………………………………………………………………
………………………………………………………………………………………………

Chief’s/ Assistant Chief’s Name & Signature Date & Stamp:

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 I. FOR OFFICIAL USE

Received by..............................................................Sub-County Children’s Officer (SCCO)

Signature: ………………………………………… Date & Stamp: ………………………….

Approved by Bursary Committee: Yes /No

Amount Approved: Kshs.…………….

Chair (Bursary Committee): ………………………… Signature: ………………. Date: ............

Secretary (SCCO): …………………………………… Signature: ………………. Date: ............

Attach the following documents:

1. Current School Report Form and K.C.P.E. Result Slip
2. School Fees Structure (indicating the School’s Bank, Branch and Account Number).
3. Copy of the School’s Admission Letter (for new students)
4. Copy of Death Certificate or Burial Permit for deceased parent/s.
5. Copy of K.C.P.E. Result Slip.
6. Passport photo

NOTE: ALL applicants MUST be students in Public boarding Secondary Schools in Kenya.

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