Final Form One Ordinary Bursary Form 2022 2023

NATIONAL GOVERNMENT CONSTITUENCIES DEVELOPMENT FUND
UGENYA
FORM ONE ORDINARY BURSARY APPLICATION FORM
SERIAL NO: NGCDF/232/BURS/2022 /2023……..................................................
DEADLINE FOR SUBMISSION
All Ordinary Bursary Form One Bursary Forms will be received between Monday
30th January, 2023 and Thursday 2nd February, 2023 at the locations listed at the
last page of this this form.
No forms will be received at the Ugenya NG-CDF Office except those from
North Ugenya on the date specified.
PART A: TO BE FILLED BY THE APPLICANT/PARENT/GUARDIAN

I. Personal, Institutional and Other Details
Full Name of Student
(As it appears in Official documents)
Gender
Date of Birth
Name of School Admitted to
Adm. No/ Reg. No.
Expected Year and month of
Completion Month……..Year………..
Parent / Guardian Mobile No.
Physical Address
Permanent Address
Location
Sub Location
Ward
Institution’s Postal Address
Institution’s Tel No
FORMER PRIMARY SCHOOL
II. FAMILY BACKGROUND (Tick where applicable)

Kindly indicate your family status;
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Total Orphan
Partial Orphan
Single Parent
Both Parents Alive
Other (State)
Number of siblings (Alive)
Estimated Family income
(annually)
Estimated family expenses
(annually)
(Attach Photocopies of death certificate(s) and verification letters from the area
chief/assistant chief where applicable)
a) Father
Name…………………………………………Address……………………………
Tel No…………………………………Occupation………………………………
Type of employment (Tick where applicable)

Permanent ( )
Contractual ( )
Casual ( )
Retired ( )
Self-employed ( )
None ( )
Main Source of Income …………………………………
b) Mother
Name…………………………………………Address……………………………
Tel No…………………………………Occupation………………………………

Permanent ( )
Contractual ( )
Casual ( )
Retired ( )
Self-employed ( )
None ( )
c) Guardian (Where applicable)
Page 2 of 5
Full Name………………………………………Address……………………
Tel No…………………………………Occupation…………………………

Permanent ( )
Contractual ( )
Casual ( )
Retired ( )
Self-employed ( )
None ( )
d) Indicate the names of siblings in school/college/university this year;

Name Secondary Colleges University Annual Fees
payable
III. APPLICANT’S ADDITIONAL INFORMATION
a. Why are you applying for a bursary? ……………………………………………

………………………………………………………………………………………………
………………………………………………………………………………
b. Have you received any financial support/bursaries from other organizations in

the past? Please provide details: …………………………………………….
………………………………………………………………………………………………
………………………………………………………………………………
IV. EDUCATION FUNDING HISTORY

i) State the main source of funding for your education In Primary School
……………………………………………………….
PART B: APPLICANT’S ACADEMIC PERFORMANCE
a) What is your average academic performance?

i. Excellent ( )
ii. Very Good ( )
Page 3 of 5
iii. Good ()
iv. Fair ()
v. Poor ()
b) Have you been sent away from school? Yes…………No……………

If yes provide reasons for your absence…………………………………
c) Specify number of weeks you stayed away from school……………
d) Annual fees (as per fee structure) Kshs
……………………………………………………
e) This Term Fees ……………………………………
f) NextTerm fees……………………………………
REFEREES
The student/parent/guardian should provide the names and telephone contacts of
at least two referees who know the family well.
1. Name…………………………………………………………….
Address………………………………………………………………
Telephone…………………………………………………. ……
2. Name…………………………………………………………….
Address……………………………………………………..
Telephone…………………………………………………..
PARENT’S /GUARDIAN’S DECLARATION

I hereby declare that the information provided herein is true to the best of my
knowledge and belief, and I understand that any false information provided shall
lead to automatic disqualification of the student.
Guardian’s/Parent’s Full Name……………………………………
Signature………………………………………………….
Date…………………………………………………..
VERIFIED BY
a) Chief/Assistant Chief
Name of area Chief/Assistant Chief…………………………

Location/Sub-location…………………………………………
Recommendation:
Recommended ( )
Not recommended ( )
Justification: …………… …………………………………………………………

…………………………………………………………………………………………
…………………………………………………………………………………………
Page 4 of 5
Signature………….……………. Date…………………………………….
Official Stamp……………………………………………………………….
FOR OFFICIAL USE ONLY (To be filled by NG-CDF Bursary Committee)

The form was duly filled and signed Yes ( ) No ( )
All supportive documents have been attached Yes ( ) No ( )
Recommended for approval ( )

Not recommended for approval ( )
Reason for non-approval ……………………………………………………………
.……………………………………………………………………………………………
Signed:
Chairman ……………………………Date -------------------------------------
Secretary …………………………….Date ……………………………...
KEY ATTACHMENTS TO THE FORM

Applicants MUST attach copies of the relevant documents including the following;
1. Photocopy of Students KCPE Result Slip.
2. Photocopy of Parents/Guardian National ID Card.
3. Photocopy of Birth Certificate.
4. Photocopy of The Admission Letter.
5. Parent (s) Death Certificate or Burial Permit (For Orphans / Partial Orphans)
6. Any other relevant supportive documents.
7. For PWD’s a letter from the Chief or Assistant Chief explaining the nature of
disability is required.
LOCATIONS WHERE BURSARY FORMS WILL BE PICKED
DATE & TIME TIME LOCATION VENUE
Monday 30th January, 8am to Ukwala East Location Yenga ACK Church
2023 5pm Ukwala Location Ukwala Town Hall
Tuesday 31st January, 8am to North West Ugenya Nyaharwa Chief’s Office.
2023 5pm Location
West Ugenya Location Assistant Chief’s Office
Masat West.
Uyunya Location Bar Achuth Chief’s Office
Wednesday 1st 8am to North Ugenya Ugenya NG-CDF Office
February, 2023 5pm Location Sega Grounds
North East Ugenya Ligala Primary School
Location Grounds.
Jera Location Chief’s Office Jera
Thursday 2nd February, 8am to Kathieno A Inungo Primary School.
2023 5pm Kathieno B Yogo Catholic Church
Kathieno C Konya Catholic Church
Anyiko Sihayi Chief’s Camp
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NATIONAL GOVERNMENT CONSTITUENCIES DEVELOPMENT FUND

PART A: TO BE FILLED BY THE APPLICANT/PARENT/GUARDIAN

II. FAMILY BACKGROUND (Tick where applicable)

Type of employment (Tick where applicable)

Type of employment (Tick where applicable)

c) Guardian (Where applicable)

Type of employment (Tick where applicable)

d) Indicate the names of siblings in school/college/university this year;

III. APPLICANT’S ADDITIONAL INFORMATION

a. Why are you applying for a bursary? ……………………………………………

b. Have you received any financial support/bursaries from other organizations in

IV. EDUCATION FUNDING HISTORY

PART B: APPLICANT’S ACADEMIC PERFORMANCE

a) What is your average academic performance?

b) Have you been sent away from school? Yes…………No……………

PARENT’S /GUARDIAN’S DECLARATION

Name of area Chief/Assistant Chief…………………………

Justification: …………… …………………………………………………………

FOR OFFICIAL USE ONLY (To be filled by NG-CDF Bursary Committee)

Recommended for approval ( )

KEY ATTACHMENTS TO THE FORM

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