Fanaa SERIAL: CGB/BURISEC ram COUNTY GOVERNMENT OF BOMET DEPARTMENT OF EDUCATION, YOUTH, SPORTS, AND VOCATIONAL TRAINING Phone 0722740149 Office of the Executive Committee Member INSTRUCTIONS/GUIDELINES Education & Vocational Training P. 0. Box 19 - 20400 BOMET ‘This application form must be filled accurately and completely in capital lett Copies of all documents required MUST be provided by the applicant. Any applications without relevant documents will not be processed. The completion and submission of this form is NOT a guarantee for bursary. County Bursary Committee reserves the right to make the final determination of bursary beneficiaries. PART A: APPLICANT'S PERSONAL INFORMATION First/Baptismal. Middle:. __Surname/Family Name: _____ Name of the school: Adm. No:. Applicants Home Address: County: Bomet County Sub County: —__—___ Ward: Location: Sub Location: Applicant's Family Status Orphan : Partial orphan Single Parent Both Low Parents’ Information Parent With Disability Parents income (without adequate source of income) | Father's First Name | Father’s middle Name Father's surname [Sees es ee) es —_ = - 4[Pa geNationality 1D Number Telephone Number Mother's first Name Mother’s Middle Name | Mother's surname Nationality |ID Number | Telephone Number If your parents are not alive, please complete the table below about your primary guardians. 1TEM GUARDIAN 1 ~ | GUARDIAN 2 First & Last Name Relationship To Applicant 1D Number Nationality Date of Birth Phone Number In the spaces below please state why you, the applicant; need sponsorship. PART D: DECLARATIONS Applicant's Declaration 1 declare that the information given above is true to the best of my knowledge and | am aware that giving false representation will not be considered and will lead to automatic disqualification. Signature. Date Parents /Guardian Declaration (Where applicable) | —__declare that the information given above is true to the best of my knowledge and | am aware that giving false representation will not be considered and will lead to automatic disqualification Signature: Date: UCT 2023 2|PagePART E: RECOMMENDATIONS ‘This part must be completed by the relevant authorities indicated. Any false information will lead to disqualification. 1. Secondary School Information Accounts section Name of School: Admission Number: Total fees required per year: Fees balance/arrears (ifany):_______Accounts Official stamp: —_____ Contact of the school Bursar: Administration/Prineipal section Please report on the named person's latest performance. Grade. How long have you known the family/ candidate? Rate the candidates Financial Ability: _Rich___Middle class___Low income__Needy _Very Needy Thave reviewed the information given in this form and I believe it to be truthful. I can affirm that he/she is needy /vulnerable. Name. Signature & Official stamp 2. Provincial Administration (Chief or Assistant Chief) How long have you known the family/ candidate? Rate the candidates Financial Ability: _Rich___Middle class. Needy Thave reviewed the information given in this form and I believe it to be truthful. I can affirm that he/she is needy /vulnerable. Name Signature & Official stamp —____ Remarks: 2 Low income___Needy__Very Contact of the Chief/Assistant chief 3. Religious Leader (Bishop, pastor, priest, imam etc) How long have you known the family/ candidate? Rate the candidates Financial Abilit Rich___Middle class. Very Needy Thave reviewed the information given in this form and I believe it to be truthful. I can affirm that he/she is needy /vulnerable. Low income__Needy Name. Signature & Official stamp Contact of Religious Leader CHECKLIST O Copy of Latest Report form* O Copy of student ID cards* D Copy of applicant birth certificate* 0 Copy of death certificate (where applicable) © & Copy of father’s ID number and Bl copy of mother’s ID number, ff or copy of other guardian’s ID* O Certified Copy of letter from a community representative (e.g, Church leader, chief, or School Head teacher) * CO Latest fees statement/fee’s structure* O Any other documentary evidence to show vulnerability. 3|PageFOR OFFICIAL USE ONLY BY THE BURSARY WARD BURSARY FUND COMMITTEE SCORE: Approved for Bursary Not Approved for Bursary Reasons: . Bursary Awarded Ksh, NB 4, This symbol means COMPULSORY attachment. 2. Ifa family is found to have misrepresented their circumstances, the bursary will be withdrawn, and they will be required to refund fees paid if already sent to their schools. 2 Completed application forms with certified copies of mandatory requirements shown in the application form should be sent or hand delivered to the Ward Education Coordinator at the ward administrators’ offices during working hours on or before 17% November 2023, 4[Page