REPUBLIC OF KENYA

MINISTRY OF EDUCATION, SCIENCE & TECHNOLOGY

FORM A
NYANDO CONSTITUENCY
TERTIARY INSTITUTION BURSARY ALLOCATION FORMS
Ahero Bible Training Centre P.O Box 85 Ahero, Kenya
Next to Ahero Magistrate court Tel 020-233450
Ahero, Kenya www.cdf.go.ke

(1) The form MUST be filled and duly signed.

(2) The following photocopies of documents MUST be enclosed (where appropriate) with this application:
 Applicant’s Identity card.
 Parent’s ID cards.
 Death certificate (s) of one parent (for a partial orphan) or of both parents (for a total orphan).
(3) The form MUST be signed by instruction administration and the information required.
(For example the bank account name of the instruction and applicant’s admission number)MUST be
filled Forms with missing information will not be accepted/processed.

PART A: STUDENT’S PERSONAL DETAILS

1. FULL NAME:
……………………………… …………………………… ………………………………….
Last First Middle
2. Sex: male ( ) female: ( )
3. Location: …………………………………….sub- location:…………Ward:………………….
Division:……………………………………...District:
…………………………………………………………………………….
Institution Admission Number:…………………………Duration of study:
From:………………to:………….
Course:……………………………………… Certificate ( ) Diploma( ) Degree ( )
If in a University do you get HELB loan? Yes ( ) No ( )
If yes, How much HELB Loan are you awarded per year?
How much bursary are you awarded by HELB per year?
Annual fees payable Kshs………………………………… Amount paid Kshs:……………
Outstanding balance Kshs:……………………………………………………………………

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PART B: FAMILY INFORMATION

1. Father’s Name:…………………………………………Occupation /Profession:………………………

2. Mother’s Name:…………………………………………Occupation/ Profession:………………………
3. Are both parents alive? Yes ( ) No ( )
(If not attach photocopies of death certificate or a report from a Sub – Chief/ Chief)
4. How many siblings do you have? How many are working /in business?
5. How many are in secondary school? How many are in Post secondary institution?
6. What is the Gross Income of the family per month?
7. Principal Source of Income:……………………Others sources:…………………………………
8. Amount spent on Education per year in (KSHS.)
9. Who has been paying for your education incase your parents are unable?
Sponsor [ ] Guardian [ ] Others (specify)………………………………….
10. Contact of who is paying for your education: Name:……………...…………… Tel:..................................

PART C: APPLICANT’S SIBLINGS IN EDUCATIONAL INSTITUTIONS

SIBLING NAME NAME OF YEARS OF TOTAL FEES FEES PAID OUTSTANDING

INSTITUTION STUDY/CLASS BALANCE

PART D: DECLARATION

1. Student Declaration
I declare that I have read this form and I hereby confirm that the information given herein is true to
the best of my knowledge.
Name: ……………………………………………….... Signature:…………………… Date:……………..

Parent’s / Guardian’s Name:………………………………Signature:……………… Date:……………..

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2. Chief/ Sub- Chief/Religious Leader
In your opinion, how needy is the applicant?
Comment:……………………………………………………………………………………………………
…………………………………………………………………………………………………………………
…………………………………………………………………………………………
I confirm that the information given herein is correct to the best of my knowledge and belief.
Location: ……………………………….. Sub- location: Official Stamp:………….……………………….
Name of Chief/Religious leader:…………………………….……………..Signature:……………………..

3. Institution Verification
Student’s conduct: Excellent V.Good Good Fair Poor
Institutional Bank Account
Name:…………………………………………………………………………………….…………………….

Address:………………………………………………… Tel No. ………………………………………….

(NOTE that no Bursary will be awarded without the correct College’s Bank account name and
official address.)
I confirm that the applicant is known to me by the names and is a registered student in this college
and that the personal details and information on collage fees are true to the best of my knowledge and
belief.
Dean of Students (Name):………………………………………………..….Signature:………..………….

Official Stamp:…………………………………..…………………….

PART E: OFFICIAL USE ONLY BY BURSARY COMMITTEE

1. Applicant’s Form is duly signed YES [ ] NO [ ]

2. Applicant has submitted supporting documents YES [ ] NO [ ]
Recommended /Not recommended for bursary (given reason):…………………………..
Bursary awarded, Kshs.

Chair’s Name :……………..……………………………....Sign:………..………….. Date:………………..

Secretary’s Name:………………………………………….......Sign :………….……. Date:……………….

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