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02P03Dec16 MARINO capitano ストラップ マリノキャピターノ レディース

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BURSARY APPLICATION FORM
STUDENTS PERSONAL INFORMATION
Full Names: ..................................................................................................................................
Gender……………………………………..Date of Birth………………………………………………………………………….
Home Address…………………………………………………………………………………………………………………………..
Masjid Near you……………………………………………………………………………………………………………………………………..
(where you live)
Telephone
Estates
Town
county
Mobile
Email: ………………………………………………………………………………………………………………………………………..
Marital Status: ………………………………………………………………………………………………………………………….
If married:
Name of Spouse: ………………………………………………………………………………………………………………………
Number of Children (if any) ……………………………………………………………………………………………………….
Do you have a job
yes
No.
Name of Employer: …………………………………………………………………………………………………………………….
Address: ………………………………………………………………………………………………………………………………………
Monthly Income ………………………….. Kshs. Other Income………………………………
Religious Background
Religion: Muslim
If Muslim: By Birth
Christian
Other:
.
Conversion
If converted: by whom……………………….when………………………mosque………………………………………………….
FAMILY INFORMATION
Father’s Name………………………………………………………………………………………………………………………………………..
(First Name)
(Middle)
other Names.
Nationality…………………………………………………… I.D No……………………………………………………………………………….
Telephone…………………………………………………………………………………………………………………………………………………
Occupation……………………………………………………………………………………………………………………………………………….
If Employed: Name of Employer …………………………………………………………………………………………………………
Sources of Income…………………………………………………………………………………………………………………………………
Monthly Income Kshs…………………………………………………………………………………………………………………………….
Religion …………………………………………………………………………………………………………………………………………………..
Mother’s Information
Name…………………………………………………………………………………………………………………………………………………………
(First name)
(Middle)
other names.
Nationality………………………………………………………… I.D No……………………………………………………………………………
Telephone…………………………………………………………Postal Address………………………………………………………………..
Occupation…………………………………………............ if Employed, Name of Employer……………………………………….
Sources of Income…………………………………………………………………………………………………………………………………….
Monthly Income: Kshs………………………………………………………………………………………………………………………………
Religion…………………………………………………………………………………………………………………………………………………….
School Information
Please attach all relevant copies of certificates and testimonials
Previous schooling
Name of your previous school………………………………………………………..
Postal address…………………………………………………………………………………
Telephone………………………………………………………………………………………
Date of Admission………………………………….. Date you left…………………………………….
Final results…………………………………………………………………
Current School
Name of Current school: ………………………………………………………………………………………………
Full Address……………………………………………………………………………………………………………………
Telephone……………………………………………………………………………………………………………………………
Class/Form/Year: …………………………………………………..Course Study……………………………………….
National/International Exams you will be sitting ……………………………………………………………………
Date of Joining…………………………………………………………………………………………………………………………….
Has your education been financed to date?...................................................................................
Sponsorship Required
Please indicate the amount of sponsorship required under each category listed below.








Registration fee…………………………………………..
Tuition fee…………………………………………………..
Examination fee……………………………………………
Activity fee ……………………………………………………
Medical ………………………………………………………..
Student card ……………………………………………………
Boarding fee…………………………………………………….
Any other…………………………………………………………
Total = ………………………………………………………………….
Please briefly state why you need the sponsorship?
…………………………………………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………………………………………
How long is the sponsorship required? …………………………………………………………………………………………………..
Referee Recommendation
Name ……………………………………………………………………………………………………………………………………………………….
First
Middle
Last
Address…………………………………………… Tel. ………………………………………………………………………………….
Occupation/kazi ………………………………………………………………………
I have read the information in this other forms and it is true and I would recommend you to consider his
application. ……………………………… / ………………………………………………….
Sign
Date
Checklist and Rules/Regulation
Please attach the entire requirement below to the application forms:
i.
1. Passport size photograph
3
ii.
iii.
iv.
v.
vi.
vii.
A copy of your birth certificate/ I.D
A copy of your parents / guardians I.D
Recommendation letter
Copies of awards, honors and certificates received.
Copies of your last scores for any test/ exam done or report form.
Fee structure for the course study/school.
Application forms should be addressed with all supporting documents to
COMMITTEE,
PWANI ONE SHILLING FOUNDATION.
P.O BOX 81267-80100
GPO MOMBASA
For official Use
Received by…………………………………………………………….. Date. ………………………………………………
1. Checked by………………………………………………. Date…………………………………………………..
2. Checked by……………………………………………….Date…………………………………………………….
3. Checked by……………………………………………….Date……………………………………………………..
RECEIPT NO……………………….. Date……………………………………….
Remarks.
…………………………………………………………………………………………………………………………………………………………………
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Final Remarks
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