MKU INTERNAL SCHOLARSHIP 2023 APPLICATION FORM
INSTRUCTIONS TO THE APPLICANT
i) The scholarship is open to ALL students studying at Mount Kenya University (any campus) irrespective of
their Nationality.
ii) The applicant MUST be REGULAR student.
iii) The applicant must be an UNDERGRADUATE student
iv) Applicants MUST have completed one ACADEMIC YEAR at MKU.
v) This application form MUST be filled accurately and completely.
vi) The applicant MUST attach certified copies of academic transcripts.
vii) Copies of ALL ADDITIONAL DOCUMENTS required MUST be provided by the applicant.
viii) The completion and submission of this form is not a guarantee of sponsorship.
ix) Any false statements, omissions or forged documents will lead to automatic disqualification.
NOTE: The decision of the University Scholarship Management Committee will be final
SECTION A: APPLICANT’S PERSONAL DETAILS
PERSONAL DATA
Full name of Applicant:
First: _________________________ Middle: _____________________ Surname: __________________________
Gender: Male: ☐ Female ☐ ID / Passport: ____________________ Admission No:_______________________
COURSE: ______________________________________ CAMPUS: ____________________________________
Department: ___________________________________________________________________________________
Age: _______ Year of Study: __________________ Intake month and year: _____________________________
Duration of Study: ____________________________ Anticipated completion date: ____________________________
Postal Address: P. O Box: _________________ Town/City: ______________________ Postal Code: ___________
Mobile No: ________________________________Alternative Mobile No: ________________________________
E-mail: _______________________________________________________________________________________
Physical Address: ____________________________________ County: ___________________________________
Ward: ________________________ Location: ______________________Sub Location: _____________________
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Tuition fee for next semester (DO NOT include statutory fee): ___________________________Fee balance (if any)
____________________(Attach certified fee statement)
Who is who responsible for paying your school fees? (tick as appropriate): Parent ☐ Guardian ☐ Self ☐
Other sources of school fees: HELB ☐: CDF ☐: County Bursary ☐: Other ☐: (specify)
________________________________________________________________________________
Physically challenged: Yes ☐ No ☐ if yes, kindly elaborate and attach the PLWD Ref number/card:
__________________________________________________________________________________________________
__________________________________________________________________________________________________
If the response above is yes, the Coordinator, Persons Abled Differently to confirm student’s physical challenge
(Associate Dean of Students for Campuses)
I_________________________________________________ ___ confirm that the student is physically challenged
Coordinator, Persons Abled Differently /Associate Dean of students’ Signature and stamp
Talents and abilities
Do you participate in co-curricular activities/innovation: Yes: ☐ No: ☐
If yes, provide details on highest award (attach certificate)_______________________________________________
(MUST have been attained while studying at MKU)
Leadership: Yes: ☐ No: ☐
If yes, provide details (attach certificate) ____________________________________________________________
(MUST have been attained while studying at MKU)
SECTION B: APPLICANT’S FAMILY INFORMATION
Tick appropriately below:
a) ORPHAN ☐ (both parents deceased)
b) PARTIALLY ORPHANED ☐ (One parent deceased)
c) NOT ORPHAN ☐ (both parents alive)
d) SINGLE PARENT ☐ (parents separated)
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MKU Internal Scholarship 2023
PARENT’S INFORMATION
Father’s Full Name
First: _________________________ Middle: _______________________ Surname: ________________________
ID / Passport No: ________________________________________ (please attach copy of ID/passport)
Living: ☐
Deceased: ☐ If deceased, please attach copy of death/Burial Certificate
Physical Address: ____________________________________ County: _______________________________
Ward: ________________________ Location: ______________________Sub Location: _____________________
Postal Address: P. O Box: _________________ Town/City: ______________________ Postal Code: ___________
Mobile No: ____________________________________________
Source of Income:______________________________________________________________________________
Mother’s Full Name
First: ________________________ Middle: ______________________ Surname: ________________________
ID / Passport No: ________________________________________ (please attach copy of ID/passport)
Living: ☐
Deceased: ☐ If deceased, please attach copy of death/Burial Certificate
Physical Address: __________________________________ County: _________________________________
Ward: _______________________Location: ____________________Sub Location: _________________________
Postal Address: P. O Box: ________________Town/City: _____________________ Postal Code: ______________
Mobile No: ________________________________Source of income:_____________________________________
Are your parents living together? Yes ☐ No ☐
GUARDIAN INFORMATION (If not living with your parents)
First: ________________________ Middle: ______________________ Surname: _________________________
ID / Passport No: ___________________________ Relationship with applicant: ____________________________
Physical Address: ____________________________________ County: _______________________________
Ward: ________________________ Location: _____________________ Sub Location: ______________________
Postal Address: P. O Box: _________________ Town/City: ______________________ Postal Code: ___________
Mobile No: ________________________________Source of income:_____________________________________
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SIBLING INFORMATION
List all your brothers and sister (excluding yourself) starting with the oldest and state what each is doing.
(If working, describe job. If in university state so; If in school, state the form or class; If in training describe it)
Name Age School/Employer Class/Position in
Employment
1.
2
4.
5.
6.
7.
8.
Disabilities or sickness of any sibling requiring specialized medical care (Describe):
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Other helpful information on any family member:
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
SECTION C: APPLICANTS EVIDENCE OF NEED
APPLICANT’S INFORMATION
Indicator Description
Why are you applying for a scholarship
Have you received any financial support/bursaries in the
past? If yes, please provide details
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Do you suffer from any chronic illness that requires
constant medication? If yes, kindly describe and provide
evidence
Who do you live with during school holidays? Parent[s]: ☐ Guardian[s]: ☐ Other: ☐ Specify:
_____________________________________________________________________________________________
PARENTS’/GUARDIANS’ INFORMATION
Indicator Father/Male Guardian Mother/Female Guardian
Age of your parents/guardians
Does any of your parents/guardians have any
disability? Describe the disability
Does any of your parents/guardians suffer from
chronic disabling medical condition? Describe.
Are your parents/guardians employed? Give details
of job and salary per month
Estimated MONTHLY income for
parents/guardians not employed
SECTION D: DECLARATIONS
APPLICANT’S DECLARATION
I, ___________________________________________ declare that the information given above is true to the best
of my knowledge and I am aware that giving false representation will mean that my application will not be considered
and will lead to automatic disqualification. I authorize MKU Foundation or its representatives to obtain such additional
information concerning this applicant’s education and financial records as needed to verify this scholarship
application. I also agree to abide by the decision of the university scholarship vetting committee.
Signature:_____________________________________________ Date: ________________________________
PARENT’S/ GUARDIAN’S DECLARATION
I confirm that the information given above is true to the best of my knowledge and I am aware that giving false
representation will mean that my application will not be considered and will lead to automatic disqualification. On
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MKU Internal Scholarship 2023
behalf of my child, I authorize MKU Foundation or its representatives to obtain such additional information
concerning this applicant’s education and financial records as needed to verify this scholarship application.
Parent’s/Guardian’s
Name:________________________________________________________________________________________
Signature: _______________________________________________ Date: ________________________________
SECTION E: MKU FINANCE DIRECTOR/CAMPUS ACCOUNTANT
Current Fee balance (Ksh) __________________________ Subsequent Semester fee (Ksh) __________________
COMMENT ON THE APPLICANT’S ELIGIBILITY
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Signature: _______________________________________________ Date: ________________________________
Stamp:
Please confirm the applicant’s fee balance
SECTION F: RECOMMENDATIONS
This part must be completed by the relevant authorities indicated. Any false information will lead to disqualification.
1. Provincial Administration (Chief or Assistant Chief)
How long have you known the applicant/family? _____________________________________________________
Rate the applicant’s financial ability ☐ Very Rich ☐ Rich ☐ Middle Income ☐ Poor ☐ Very Poor
Yes No
Orphaned ☐ ☐
Parent/Guardians are employed ☐ ☐
Explain any additional information
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I have reviewed the information in this form and believe it to be truthful. The above named student is a resident of my
Location/Sub-Location. Based on my knowledge and/or inquiries, I affirm that he/she is needy/vulnerable.
Name: __________________________ Signature & Official Stamp:____________________ Date: _____________
Postal Address: P. O Box: _________________ Town/City: ______________________ Postal Code: ___________
Mobile No: ____________________________________________
2. Religious Leader (This section is NOT to be signed by any student Christian/Religious Leader)
How long have you known the applicant/family? _____________________________________________________
Rate the applicant’s financial ability ☐ Very Rich ☐ Rich ☐ Middle Income ☐ Poor ☐ Very Poor
Yes No
Orphaned ☐ ☐
Parent/Guardians are employed ☐ ☐
Explain any additional information
I have reviewed the information in this form and believe it to be truthful. The above named student is a member of
my church. Based on my knowledge and/or inquiries, I affirm that he/she is needy/vulnerable.
Name: __________________________ Signature & Official Stamp:____________________ Date: _____________
Postal Address: P. O Box: _________________ Town/City: ______________________ Postal Code: ___________
Mobile No: ____________________________________________
SECTION G: SUBMISSION CHECKLIST
1. Duly completed and signed application form
2. Copy of Student ID
3. Certified MKU academic transcripts/results slip
4. Certified fee statement
5. Copy of parent’s/guardian’s ID/Passport (If deceased death/burial certificate)
6. Emailed soft copy of application form and attachments
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SECTION H: SUBMISSION OF APPLICATION
Submission of application form must be in BOTH hard and soft copies by Friday, 30th September 2022; 1700hrs.
Duly filled application forms to be submitted as follows:
1. Soft copy
The applicant must scan and produce electronic copies of the Application Form and the necessary attachments, convert
them to a single PDF document and mail to:
Email address: mkufoundation@mku.ac.ke
Email Subject: MKU INTERNAL SCHOLARSHIP 2023
2. Hard copy
The application letter should be addressed as follows;
MKU Internal Scholarship Application Documents
Mount Kenya University Foundation
Alumni Plaza, 9th Floor, Room 916
P.O. Box 342-01000
THIKA
The application documents should be delivered to the Foundation Office (for Thika Campus applicants), or at the
respective Campus Director’s Office (for applicants in Campuses and Centers)
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OFFICIAL USE: FINAL REMARK//RECOMMENDATION.
RECEIVED BY: ______________________________________________________________________________________
SIGNATURE AND STAMP OF THE OFFICIAL
____________________________________________________________________________________________________
DATE: ______________________________________________________________________________________________
VETTING RESULTS
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
RECOMMENDATIONS OF THE SCHOLARSHIP MANAGEMENT COMMITTEE
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
___________________________________________________________________________________________________
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