MASOMO FOUNDATION Passport size

P.O. BOX 40613, NAIROBI – 00100 Photograph

MOBILE: 0722762477, 0752-092892
E-MAIL: info@masomofoundation.com
Website @: WWW: masomofoundation.com

APPLICATION FORM FOR UNIVERSITY SCHOLARSHIP

NOTES
1 APPLICATION SHOULD BE ACCOMPANIED BY FINAL RESULT SLIP (K.C.S.E.)
2 ABOVE 18 YEARS STUDENTS SHOULD ATTACH THEIR NATIONAL I.D
3 ALL STUDENTS ARE REQUIRED TO OBSERVE RULES AND REGULATIONS OF THEIR RESPECTIVE
UNIVERSITIES AND BE MODEL STUDENT.
4 STUDENTS WILL NOT ENGAGE IN IMMORAL ACTIVITIES, CRIMINAL OR DRUG ABUSE.
5 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

1st Name Middle name Surname

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

Students Address…………………..Telephone No……………………E-Mail ………………….……………..

Name of university…………………………………………………….…….Admn. No…………………….…..

University Address - P.O. Box………………… Town……………..…….. Postal code……………………

Telephone No………………………………E-mail Address……………………………………………………….

Course leading to Degree …………………………………..Duration of course…………………………………

Father’s Name…………………………………..Mothers Name………………………… ………………………

Parent’s Postal Address…………………………. Telephone No………………..……………………………….

Residence address……………………………… County………………………………………………………..

Parents annual earnings …………………………Employed or Self employed…………………………………

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

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

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

Have you applied for HELB loan…………………….How much……………………………………………..

Amount expected from Masomo Foundation……………………………………………………………………

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

DATE OF APPLICATION…………………STUDENT’S SIGNATURE…………………...I.D………….…………