NG National Government Constituencies Development Fund Rongai

P.OBox 12848-20100
Nakuru, Kenya
Tel: 0791490923/
0777490922
Website: https://rongai.ngcdf.go.ke/
UNTVERSITY & COLLEGE BURSARY APPLICATION FORM FOR 2023/2024 FINANCIAL
YEAR
PART I: PERSONAL DETAILS
Name of the applicant,
Name of the Institution (name in full)

Admission/Registration No.
National ID/NO

Level of Education (tick one) :Certificate ( ) Diploma () Degree ( ) Masters ( ) PhD ()

Expected year of completion,
Gender: () Male ( ) Female ( )Other RONGAI CDF
Learner with special needs (tick one): Yes ( ) No ( )
2 4 NOV 2023
Home address (applicant's): PO, Box 12848, NAK!PU

Telephone (applicants or guardian):

Ward Location Sub-location
PART2: INSTITUTION'S INFORMATION
Category (tick one): Regular () Parallel ()
Address:
Tel:

PART 3: FAMILYBACKGROUND
Please Tick where appropriate.

Total Orphan () Partial Orphan () Single Parent () Both Parents

Alive () Parents are PWDs ()
Father's name: Occupation, (If alive)
Mother's name:
Guardian's name: Occupation, (If alive)
Occupation
Indicate the names of other siblings in
annually by the brothers and sisters. colleges/universities
this year. Give a breakdown of fees paid
Name
College/University Name Total Amount

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DECLARATION
PART 1: STUDENT'S DECLARATIONV
Ideclare that the information given herein is true to my knowledge and belief.
Date
Student's signature.
PART 2: PARENT'S/GUARDIAN'S DECLARATION
Ideclare that the information given herein is true to my knowledge and belief.
ID NO: Date
Parent's/Guardian's Signature:
PART 3AREA CHIEE/ASSISTANT CHIEF REMARKS
Family Background [tick where appropriatel
Parcnts are PWDs ()
Total Orphan () Partial Orphan () Single Parent (O Both Parents Alive ()
Name of the Chief/Assistant Chief

Sign:
Stamp Date_

FOR OFFICIAL USE ONLY

This form was dully filled and signed: Yes ( ) No ( )

All support documents have been attached: Yes ( ) No ( )

Amount awarded

Remarks:
Date
Sign,
Stamp_

ITEMS TO ATTACH (copies)

RONGAICDF!
1. Orphans: Parent (s) death certificates or burial permit
2. Current fee structure & Fees statement of the previous semester 2 4 NOV 2023
3. Photocopy of the national ID NAKURU
4. Photocopy of the school ID P.0. Box 12%48,
TEL: 020-943C039
5. Photocopy of voters card
NB: Any false information provided will lead to automatic disqualiication.

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