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KeNHA App

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38 views

KeNHA App

Uploaded by

mtoto20239
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
You are on page 1/ 5

PART A: APPLICANT’S PERSONAL DETAILS

Education Level Academic Performance (Marks/Grade) Year of Exam


Primary School (Attach Result Slip
& School Leaving Certificate
Certified by School)
Secondary School (Attach Result Slip
& School Leaving Certificate
Certified by School)

Do you have any special needs (Tick Appropriately) Yes No

Visually Challenged (Provide Evidence)


(Attachment)
Physically Challenged (Provide Evidence)
(Attachment)

Hearing (Provide Evidence) (Attachment)

Other (Specify) (Provide Evidence) (Attachment)

Course(s) you are applying for

Option 1 Institution

Course
Option 2 Institution

Course

Is your household in the Yes No


National Land
Commission list

If the answer to the above Name Tel. No. Male female


is yes, please provide
details of the name and the
contact
details of the household
head
PART B: PARENTS’ DETAILS
Parents’ Marital Single Married Divorced Widowed
Status

FATHER MOTHER
Yes No Yes
a) Is your father alive? . a) Is your mother alive? No

b) If yes give his age; b) If yes give her age;

c)Name: _ c) Name:

d) ID No. d)ID No.

e) Occupation:
e) Occupation:

f) Phone Number f) Phone Number


g) Name and address of employer(s) g) Name and address of employer(s)

h) If retired give name(s) and address of last h) If retired give name(s) and address of last
employer(s); employer(s);

Year of retirement: Year of retirement:


Employer’s Telephone No: Employer’s Telephone No:

Guardian Details (If Applicable)


Guardian’s Name

Guardian’s Phone Number

Guardian’s Email Address


Guardian’s Postal Address
PART C: INFORMATION ABOUT FINANCIAL STATUS
a. Approximate current gross family income per month.

Item Father Mother Total

Gross income from


employment (Salary or
Pension)
Income from Business e.g., Shop,
Hotel, Matatu.

Income from farming e.g., Crops,


Livestock, Fishing.

Income from other


sources e.g.,
Shares, Dividends,
Interest
Income from Harambee and
Donations.
Others e.g., CDF, HELB, NGO
TOTAL

(b) Applicant’s Siblings in Educational Institution (Please include


documentary evidence)

Child’s Name Institution Name Year of Expected


Study Education
Expenditures
1.
2.
3.
4.
6.
TOTAL
APPLICANT CERTIFICATION

I hereby certify that all the information I have provided on this form and all supplementary forms
is true, correct, and complete. I hereby authorize KeNHA or its representatives to obtain such
additional information concerning my educational program and financial records needed to
complete processing of this application. It is also my understanding that KeNHA, may, as it
seems appropriate, release to others who may be considering me for financial assistance or
making decisions relating to my educational plans, information concerning the amount of any
award I may receive. Any falsified information may lead to disqualification.

Applicant signature: Date:

LOCAL ADMINISTRATION CERTIFICATION


I certify that the above applicant is a resident of Sub- location/Location/Sub- County within

County.

DCC’s, Area Chief Stamp and Signature: Date:

FOR OFFICIAL USE ONLY (KeNHA Regional Offices in Isiolo and Garissa or at the Isiolo
County Commissioner’s office, Meru County Commissioner’s office., Garissa County
Commissioner’s office and Wajir County Commissioner’s office and Area Chief)

Date Received Receiving Officer Signature


[FOR AND ON BEHALF OF KENYA NATIONAL HIGHWAYS AUTHORITY]

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