Email - Cdfkipipiri@cdf - Go.ke: Vision: Equitable Social-Economic Development Countrywide

NATIONAL GOVERNMENT - CONSTITUENCIES DEVELOPMENT FUND OF KIPIPIRI
P.O. BOX25-20301, MIHARATI.
Cell: 0729963042Email.cdfkipipiri@cdf.go.ke
KIPIPIRI NG-CDF SECONDARY SCHOOLS BURSARY FORM
PART: 1 INSTRUCTION
1.
Kindly provide information in legible CAPITAL letters
2.
Attach fees structure and result slip(A MUST)
3.
Attach copies of Parents/Guardian National ID
4.
If Parent(s) is/are deceased, attach death certificate(A MUST)
5.
Submission of incomplete forms may lead to DISQUALIFICATION All forms shall be returned at the
Kipipiri C.D.F office Miharati
6. Successful applicants will have the awarded bursary paid directly to Secondary school
PART: 2 STUDENTS PERSONAL INFORMATION.
1. Full Name: Surname................................First Name..........................Other Name ................................

2. Gender: Male ( ) Female ( )
3. Status of the Applicant: Total Orphan [ ] Partial Orphan [ ] Needy [ ]
4. Who pays your fees: Father [ ] Mother [ ] Guardian [ ] Sponsored [ ] Self [ ]
5. Date of birth..............................Adm No. .................... Form: ………..Mobile No............................
6. Name of Institution............................................Institution Address..................Year of Study…..............
7. Secondary School: Boarding Secondary [ ] Day Secondary [ ] Special School [ ]
WARD ...........................LOCATION..............................VILLAGE/ESTATE..................................................
PART 3:STUDENTS JOINING FORM ONE (please attach joining instructions)
a. Former primary school______________________________________________

b. KCPE marks______________________________
c. School admitted: National.................................... County ....................Sub-County.........
d. Former Primary School H/Teacher

Student/Pupil conduct: Excellent.................. V/Good............... Good................ Fair.........
I declare to the best of my knowledge that the above information is true/or the applicant to attach a copy of certified
school leaving certificate.
............................................................ ............................................... ..........................

NAME SIGN DATE/SCHOOL
STAMP……………………………...
PART 4: FAMILY INFORMATION

Vision: Equitable social-economic development countrywide
ISO 9001:2008 Certified

1. Father’s name _________________________________ Occupation ______________________
ID No.____________ Phone Number_________________ Village________________________
2. Mother’s name _____________________________________Occupation ___________________
ID No._____________ Phone Number_________________ Village_______________________
3. Guardian’s name ____________________________________Occupation __________________
ID No.___________ Phone Number_________________ Village_______________________
PART 5: CHIEF/SUB CHIEF

Comment on the status of the family/parent
........................................................................................................................................................
........................................................................................................................................................
I declare that the information contained herein is correct to the best of my knowledge and belief.
I confirm that that the applicant is known to me and is a resident of my location.
Chief’s Name_____________________________Signature___________
Location _________________________ Date _____________________
PART 6:DECLARATION (Official Stamp)

Student’s Declaration
Why are you applying for this
bursary....................................................................................................................................................
Have you received/Applied for any financial support/bursary in this financial year from;
(a) County/Ward [ Yes] [No] (b) Presidential [ Yes] [No] (c) NGAAF (Women rep ) [ Yes] [No]
(d) Any other specify……………………………………………………………………………………………
PART 7: Parent’s Declaration

I declare that I have read this form/this information has been read to me and I have confirmed that the information
given here is true.
Parent’s/Guardian’s Name: ______________________________________________________________
Parent’s/Guardian’s signature: __________________________ Date: ____________________________
PART 8:FOR OFFICIAL USE ONLY BY THE CONSTITUENCY BURSARY COMMITTEE.
SCORE......................................................
...............................Approved for Bursary ........................ Not approved for bursary: reasons

REASON: …………………………………
.......................................................
......................................................
Chairman: ........................................... Sign........................................... Date ...................
Secretary: ............................................ Sign........................................... Date ...................
Official Stamp...............................................................................................

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NATIONAL GOVERNMENT - CONSTITUENCIES DEVELOPMENT FUND OF KIPIPIRI

P.O. BOX25-20301, MIHARATI.

1. Full Name: Surname................................First Name..........................Other Name ................................

PART 3:STUDENTS JOINING FORM ONE (please attach joining instructions)

a. Former primary school______________________________________________

d. Former Primary School H/Teacher

............................................................ ............................................... ..........................

PART 4: FAMILY INFORMATION

ISO 9001:2008 Certified

P.O. BOX25-20301, MIHARATI.

ID No.____________ Phone Number_________________ Village________________________

2. Mother’s name _____________________________________Occupation ___________________

ID No._____________ Phone Number_________________ Village_______________________

3. Guardian’s name ____________________________________Occupation __________________

ID No.___________ Phone Number_________________ Village_______________________

PART 5: CHIEF/SUB CHIEF

I confirm that that the applicant is known to me and is a resident of my location.

Location _________________________ Date _____________________

PART 6:DECLARATION (Official Stamp)

(d) Any other specify……………………………………………………………………………………………

PART 7: Parent’s Declaration

Vision: Equitable social-economic development countrywide

ISO 9001:2008 Certified

P.O. BOX25-20301, MIHARATI.

Parent’s/Guardian’s Name: ______________________________________________________________

Parent’s/Guardian’s signature: __________________________ Date: ____________________________

PART 8:FOR OFFICIAL USE ONLY BY THE CONSTITUENCY BURSARY COMMITTEE.

...............................Approved for Bursary ........................ Not approved for bursary: reasons

Chairman: ........................................... Sign........................................... Date ...................

Secretary: ............................................ Sign........................................... Date ...................

Vision: Equitable social-economic development countrywide

ISO 9001:2008 Certified

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ID No.____ Phone Number_ Village________________

2. Mother’s name ___________________Occupation _

ID No._____ Phone Number_ Village_______________

3. Guardian’s name __________________Occupation

ID No.___ Phone Number_ Village_______________

Location _____ Date _

Parent’s/Guardian’s signature: Date: __