MASOMO FOUNDATION

P.O. BOX 40613, NAIROBI – 00100

, MOBILE: 0722762477
E-MAIL: info@masomofoundation.com
Website @: WWW:masomofoundation.com

APPLICATION FORM FOR BURSARY / SCHOLARSHIP

NOTES
1 APPLICATION SHOULD BE ACCOMPANIED BY FINAL RESULT SLIP
2 APPLICATION MUST HAVE SCORED 78% MARKS AND ABOVE
3 APPLICATION MUST BE CERTIFIED BY RELIGIOUS COMMITTEE
4 APPLICATION SHOULD BE ACCOMPANIED BY BIRTH CERTIFICATE
5 ABOVE 18 YEARS STUDENTS SHOULD ATTACH THEIR NATIONAL I.D
6 ALL STUDENTS ARE REQUIRED TO OBSERVE RULES AND REGULATIONS OF THEIR RESPECTIVE
SCHOOLS AND TO BE MODEL STUDENTS.
7 STUDENTS WILL NOT ENGAGE IN IMMORAL OR CRIMINAL ACTIVITIES.
8 UPON COMPLETION OF THEIR EDUCATION, STUDENTS ARE REQUIRED TO ACTIVELY SEEK
EMPLOYMENT, WHEREUPON THEY SHALL REIMBURSE ALL THE MONEY SPENT BY MASOMO
FOUNDATION

I shall be grateful if you kindly consider my application for fees for the year …………………………………

Name of student……………………………………………………………………………………male / female

Date of birth……………………Place………………………………..District………………………………….

Class of admission…………………………………………………….…….Admn. No…………………….…..

(KCPE results slip photocopies to be attached)

Name of calling school……………………………………………….National / Provincial / District / Private

Address of the School………………………………………………..Telephone……………….…………….

Father’s Name…………………………………………………………Copy of I.D.No………………………

Mother’s Name……………………………………………………… Copy of I.D.No………………………

Parent’s address / Telephone No………………………………………District……………………………….

Residence address…………………………………………………… Province………………………………

Name of Mother’s / father’s employer………………………………………………………………………….

Address of his / her employer……………………………………………………………………………………

If self employed, as what…………………………………………………………………………………………

His / Her annual earnings………………………………………………………………………………………

Other school going children in the family…………………………………………………………………….

………………………………………………………………………………………………………………….

Name of their school(s)…………………………………………………………………………………………

How did you pay your last school fees………………………………………………………………………….

DATE OF APPLICATION………………………………….PARENT’S SIGNATURE………………………………

 THIS PORTION IS TO BE COMPLETED BY THE RELIGIOUS COMMITTEE
LEADERS

We certify that the applicant is a genuine case who deserves assistance

Chairman …………………………………………………Secretary………………………………..

(ID. Nos. & Copies)………………………………………………………………………………..

Signature: Chairman………………………………………………
Signature: Secretary………………………………………………
Official rubber stamp

THIS PORTION IS TO BE COMPLETED BY THE PRIMARY SCHOOL HEAD

I……………………………………………………….the school head teacher certify that the referred

particulars of the above student are true and correct. I further recommend the student be granted

bursary / scholarship for the following reasons:……………………………………………………….

………………………………………………………………………………………………………..
Signature of the Head Teacher………………………………
Official rubber stamp

THIS PORTION TO BE COMPLETED BY THE AREA CHIEF

We certify that the applicant is a genuine case who deserves assistance

Name …………………………………………………Tel. No………………………………..

Signature of the Chief………………………..

Official rubber stamp

Annual School Fees are as follows:-

1ST TERM KSH
ND
2 TERM KSH
3RD TERM KSH
TH
4 TERM KSH
Fees already paid KSH
Total Fees for the year KSH