Nyaribari Chache Secondary School Bursary Form Fy 2022 - 2023

Serial No……………………..
SECONDARY SCHOOLS BURSARY APPLICATION FORM FY. 2023-2024

National Government Constituencies Development Fund
Nyaribari Chache Constituency
NG-CDFB P.O Box 78Keumbu- 40212
Email: cdfnyaribarichache@ngcdf.go.ke
NYARIBARI CHACHE SECONDARY SCHOOLS

SCHOLARSHIP/BURSARY APPLICATION FORM
(FINANCIAL YEAR 2023/2024)
DATE 05/02/2024
PART I: INSTRUCTIONS
(Please, read all the instructions carefully and fill in the form accurately)
1. The Student to be considered MUST be a resident of Nyaribari Chache Constituency
2. The Student to be considered MUST be needy and deserving
3. The student to be considered MUST not be in any other scholarship scheme
4. Submit a duly filled application form to your respective ward. The date for submission will announced
later
5. All sections of the form must be filled. The applicant MUST insert his/ her Index Number/Admission
Number on all pages as indicated.
6. All bursary forms will be collected at designated areas within the wards on 14TH FEBRUARY
2024
I. KIOGORO KIOGORO CDF OFFICE

II. KEUMBU KEUMBU CDF OFFICE
III. BIRONGO CHIRICHIRO CHIEF’S OFFICE
IV. KISII CENTRAL MENYINKWA MARKET
V. BOBARACHO KEGATI CHIEF’S OFFICE
VI. IBENO NYABISABO MARKET
COMPULSORY ATTACHMENTS:
Vision: To be a leading public institution in the effective and efficient management of devolved funds Page1 of 6
ISO 9001:2015Certified
i) Copy of Student KCPE Result Slip certified by the School Head Teacher.
ii) Copy of admission letter & fee structure.
iii) Copy of current report form (Form II-I)
iv) Copy of Parent’s/ Guardian’s ID Cards or Death Certificates where applicable
v) Copy of Student’s Birth Certificate.
This application is not a guarantee for a scholarship award
7. Bursary once allocated is ONLY TRANSFERABLE WITH A WRITTEN APPROVAL FROM THE
FUND ACCOUNT MANAGER, NYARIBARI CHACHE NG-CDF. Cheques will be written in favour
of the institution named in PART III (f) and not to individual applicants’ names
PART II: STUDENT PERSONAL DETAILS
1. Full name (As in Birth Certificate)

FIRST MIDDLE LAST
2. Gender: Male □ Female □ Date of Birth: ____/____/______
Ward Location Sub-Location Estate/ Village
3. Are you from a child headed household? Yes □ No□
4. Are you a child of a single parent? Yes □ No□
5. Have you lost any of your parents (Attach death certificate)?
Father: Yes□ No□ Mother: □ Yes No□
6. Are you disabled? Yes □ No.□
7. If yes, please describe in the space provided the nature of

your disability.
_____________________________________________________________________________
8. Are any of your parents disabled? Yes □ No.□
9. If yes, please describe in the space provided the nature of the disability and attach proof (medical
report, photograph and letter from sub chief/ chief)
10. Please fill in the following details of your parents (if still alive)
Details Father Mother Guardian
Name
Occupation/ Profession
Other source of income –

farming, business etc.
Employed? (Yes/ No /
Retired)
Average Monthly Income
Cell phone number
11. Student’s Contact Person:
Name............................................................. Relations with Student……………..……..…………

Ward…………………………………..SubLocation.....................................................................…...
Estate/ Village………………………………...…………. Contact…………………………………..
PART III: SCHOOL
a. Name of Primary School Attended:_____________________________________________
b. Index Number (Include School code): ______________________________________________
c. Marks Attained:____________________
d. Name of Head Teacher_________________________________________________
e. Contact of Head Teacher________________________________________________
f. Secondary School Admitted to _____________________________________________
g. Breakdown of Fees Per Year:
Term 1__________________ Term 2____________________ Term 3____________________
Other Charges__________________________
PART IV: PARENTS’/ GUARDIAN’S OTHER EDUCATIONAL RESPONSIBLITIES

NAME OF SIBLING INSTITUTION YEAR OF TOTAL FEES SPONSORS (IF ANY)
OF LEARNING STUDY
KSHS
TOTAL
PART V: DECLARATION
1. STUDENT
I __________________________________________ hereby declare that the information given herein is true to

the best of my knowledge and hereby accept that any false information will automatically disqualify my
application.
Signature: ____________________________ Date: ___________________
2. PARENT/ GUARDIAN OF THE APPLICANT
I declare that I have read this form/ this form has been read to me, and hereby confirm that the information
given herein is true to the best of my knowledge and hereby accept that any false information will automatically
disqualify this application.
Parent/ Guardian’s Name: _____________________________________________________________
Signature/ Date: _______________________ I/D No ________________ Cell No _________________
3. CHIEF/ASSISTANT CHIEF
I certify that the applicant is a resident of ……………………………Sub- Location in

………….……..…… Location, Nyaribari Chache Constituency and that I have checked all the
information given herein and hereby confirm that they are complete and true to the best of my
knowledge.
Comment on family financial status _________________________________________________________
____________________________________________________________________________________
_______________________________ _________________________ _____________________
NAME Signature/ Official Stamp Date
PART VI: FOR OFFICIAL USE ONLY BY NYARIBARI CHACHE NG-CDF BURSARY SUB-
COMMITTEE
Scholarship Awarded: Full............. Partial……….…. None……………..
Equivalent Amount (Kshs) ……………………………..
Please give reasons for the decision: ______________________________________________________
Secretary Chairman
Name ______________________________________ _____________________________________
Signature__________________ Date ____________ Signature_____________ Date ___________

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Serial No……………………..

SECONDARY SCHOOLS BURSARY APPLICATION FORM FY. 2023-2024

NG-CDFB P.O Box 78Keumbu- 40212

NYARIBARI CHACHE SECONDARY SCHOOLS

1. The Student to be considered MUST be a resident of Nyaribari Chache Constituency

2. The Student to be considered MUST be needy and deserving

3. The student to be considered MUST not be in any other scholarship scheme

I. KIOGORO KIOGORO CDF OFFICE

NG-CDFB P.O Box 78Keumbu- 40212

ii) Copy of admission letter & fee structure.

iii) Copy of current report form (Form II-I)

iv) Copy of Parent’s/ Guardian’s ID Cards or Death Certificates where applicable

v) Copy of Student’s Birth Certificate.

This application is not a guarantee for a scholarship award

PART II: STUDENT PERSONAL DETAILS

1. Full name (As in Birth Certificate)

2. Gender: Male □ Female □ Date of Birth: ____/____/______

Ward Location Sub-Location Estate/ Village

3. Are you from a child headed household? Yes □ No□

4. Are you a child of a single parent? Yes □ No□

5. Have you lost any of your parents (Attach death certificate)?

Father: Yes□ No□ Mother: □ Yes No□

NG-CDFB P.O Box 78Keumbu- 40212

6. Are you disabled? Yes □ No.□

7. If yes, please describe in the space provided the nature of

8. Are any of your parents disabled? Yes □ No.□

Other source of income –

Average Monthly Income

Cell phone number

11. Student’s Contact Person:

Name............................................................. Relations with Student……………..……..…………

Estate/ Village………………………………...…………. Contact…………………………………..

NG-CDFB P.O Box 78Keumbu- 40212

PART III: SCHOOL

a. Name of Primary School Attended:_____________________________________________

b. Index Number (Include School code): ______________________________________________

PART IV: PARENTS’/ GUARDIAN’S OTHER EDUCATIONAL RESPONSIBLITIES

NG-CDFB P.O Box 78Keumbu- 40212

I __________________________________________ hereby declare that the information given herein is true to

Signature: ____________________________ Date: ___________________

2. PARENT/ GUARDIAN OF THE APPLICANT

Parent/ Guardian’s Name: _____________________________________________________________

Signature/ Date: _______________________ I/D No ________________ Cell No _________________

I certify that the applicant is a resident of ……………………………Sub- Location in

Comment on family financial status _________________________________________________________

_______________________________ _________________________ _____________________

NAME Signature/ Official Stamp Date

NG-CDFB P.O Box 78Keumbu- 40212

Scholarship Awarded: Full............. Partial……….…. None……………..

Equivalent Amount (Kshs) ……………………………..

Please give reasons for the decision: ______________________________________________________

Name ______________________________________ _____________________________________

Signature__________________ Date ____________ Signature_____________ Date ___________

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2. Gender: Male □ Female □ Date of Birth: //__

Signature: __________ Date: _

Signature/ Date: _______ I/D No Cell No _

___________________ _ _________

Name __ _

Signature____________ Date Signature_ Date _____