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National Government Constituencies Development Fund

Mwala Constituency
P.o Box 858-0090100
MACHAKOS
Tel:............................| Cell: 0722 594 319
Email:[email protected]|Website:www.ngcdf.go.ke
NG-CDF Mwala

BURSARY APPLICATION FORM SN. 42065595

Names BRIAN NDETI NZIOKA

Gender M

PWD? N

ID/Birth/PP No. 42065595

Institution CO-OPERATIVE UNIVERSITY OF KENYA

Admission No. T021/300655/2023

Year of study 1

Semester 1

Course Duration 2

Mobile Number +254713302240

Email ID [email protected]

Ward MASII

Location MASII

Sub Location MBAANI

Village KAWAA

Level of Study Diploma

Mode of Study FULL TIME

Family BOTH PARENTS ALIVE

Income (Father) NO SPECIFIC SOURCE OF INCOME

Income (Mother) NO SPECIFIC SOURCE OF INCOME

Date of Application 2023-11-17 20:27:51

Note: This form should be presented IN PERSON during the annual university/ college students meeting. You will be required to sign

and produce this form togther with a copy of 1). Your id card or birth certificate 2) Your student ID or admission letter. The attachments

are required for our verificatons to filter ghost applicants. Failure to attach the said copies will lead to automatic disqualification

STAMP......................... SIGN..........................

CHIEF (MASII LOCATION ) BRIAN NDETI NZIOKA

I, Chief (MASII location ), do ascertain that the I, BRIAN NDETI NZIOKA , declare that the

above information is true to the best of my above information is true to the best of my

knowledge knowledge

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