Sponsorship Application Form 2019: Place Passport Size Photo of The Applicant Here

Place passport size
Photo of the applicant

here.
Sponsorship Application Form 2019

This application form should be completed IN FULL by applicants from very needy families who attended a
public primary school, scored at least 370 marks and are admitted to a NATIONAL or EXTRA-COUNTY
Secondary School. Needy students sponsored through private primary schools DO NOT QUALIFY.
Applicants MUST attend interviews at venues to be advertised in the Daily Nation Newspaper and the
website.
It is a criminal offence to provide false information in this application. Any person who does so may be
recommended for prosecution and the applicant will be automatically disqualified.
You must bring to the interview the following documents with this application form:
 *An Original and Copy of your KCPE Results Slip.
 *An Original and Copy of your Secondary School Admission Letter.
 A Passport sized photograph placed at the top of this form.
* Palmhouse Foundation will not retain any original documents. Documents submitted will not be
returned.
PART I: PERSONAL & FAMILY DETAILS

Full name of applicant:
(First name) (Middle name) (Surname)
Name of Primary school: Date of Birth
Applicant’s Index No: County of Primary School:
Secondary School admitted to:
Contact Person for the Applicant:
Name: Relation .
Telephone No. .
ACADEMIC INFORMATION
Name of primary school attended:
Class 1-4 .
Physical address: County: Sub county: .
Name of primary school attended:
Class 5-8 .
Physical address: County: Sub county: .
Is this Your First K.C.P.E attempt? YES NO
If no, how many times? _______ Please indicate the KCPE scores attained for previous years: _______
IT IS A CRIMINAL OFFENCE TO PROVIDE FALSE INFORMATION IN THIS APPLICATION FORM.

DETAILS OF FAMILY CIRCUMSTANCES:
Father Mother Guardian
Name
Age of your parents/guardians:
YES NO YES NO YES NO
Do any of your parents have any
form of disability?
Are you living with both parents?
Are your parents/guardians
employed?
Do your parents/guardians own
any form of business?
Do your parents/guardians own
land/plot?
Do your parents/guardians have any
other assets or sources of income,
including casual labor?
If you stated Guardian above, indicate the relationship with the Guardian (e.g.,
Uncle/Aunt/Grandfather/Grandmother/Sister/Brother. If not a relative explain the relationship)
Has your family been affected by civil conflict or natural disasters such as displacement, flooding, drought,
fire or famine?
YES NO
If yes, describe __________________________________________________________________________
SIBLING INFORMATION
List all your brothers and sisters starting with the oldest and state what each is doing.
Class/Position in
Name Age School/Employer
employment
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

PART C: APPLICANT’S EVIDENCE OF NEED
Indicator Description
Why are you applying for a scholarship?
YES NO
Have you received any financial support/bursaries
in the past?
Do you suffer from any physical impairment
(disability)?
Do you have any disability or any chronic illness?
Are you entitled to any form of inheritance from
your Parents/Guardians/any other source?
Who do you live with?

Parent(s) Guardian Others specify .
To be completed by parent or guardian: Briefly explain below why the family cannot afford to pay the
applicant’s school fees:
Name:
Relation to applicant:
Signature: Date:
ID No. Mobile No:
PART II: RECOMMENDATIONS
Confirmation and recommendation by Primary School Headmaster/Headmistress:

I confirm that (Name of Pupil) was a pupil in my school. I also
confirm that he/she has now been admitted into the National/County School and obtained marks as
indicated in Part I of this form.
I recommend that this pupil be supported by Palmhouse Foundation on the following grounds:
Family circumstances:
Leadership Potential:
Character/ conduct:
Special interests/ sporting activities:
Headmaster’s Signature: School stamp:

Headmaster’s Name: Date:
ID No. TSC No: Mobile No:
Recommendation by a local leader (Chief or Sub-Chief)
I have read the information provided in this form and believe it to be truthful. Based on my knowledge of
the family and/or inquiries I have made, I make the following recommendation regarding the needy
circumstances and conduct of this applicant:
Are they currently or have they been previously employed?
Relation YES NO Where? Please include a brief summary of your recommendation.
Father
Mother
Guardian
Brothers
Sisters
Signature: Date:
Name: Mobile No:
ID No.
Position: Stamp:
Recommendation by a spiritual leader (Priest, Pastor, Imam etc.)

I have read the information provided in this form and believe it to be truthful. Based on my knowledge of
the family and/or inquiries I have made, I make the following recommendation regarding the needy
circumstances and conduct of this applicant:
Signature:
Name: Date:
ID No. Mobile No:
Organisation: Position:
Stamp:

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Sponsorship Application Form 2019

PART I: PERSONAL & FAMILY DETAILS

Name of Primary school: Date of Birth

Applicant’s Index No: County of Primary School:

Secondary School admitted to:

Contact Person for the Applicant:

IT IS A CRIMINAL OFFENCE TO PROVIDE FALSE INFORMATION IN THIS APPLICATION FORM.

If yes, describe __________________________________________________________________________

IT IS A CRIMINAL OFFENCE TO PROVIDE FALSE INFORMATION IN THIS APPLICATION FORM.

Who do you live with?

PART II: RECOMMENDATIONS

Confirmation and recommendation by Primary School Headmaster/Headmistress:

Special interests/ sporting activities:

Headmaster’s Signature: School stamp:

Relation YES NO Where? Please include a brief summary of your recommendation.

Recommendation by a spiritual leader (Priest, Pastor, Imam etc.)

IT IS A CRIMINAL OFFENCE TO PROVIDE FALSE INFORMATION IN THIS APPLICATION FORM.

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