TOWER SACCO EDUCATION SCHOLARSHIP
APPLICATION FORM
Tower SACCO Branch _____________________________
PROGRAM INSTRUCTIONS/GUIDELINES
1. This form is given FREE OF CHARGE by Tower SACCO Education Scholarship program.
2. The information provided in this form is intended to help Tower SACCO Education Committee
understand the applicant’s academic and financial position for the purpose of assessment for
scholarship/award.
3. This application form must be filled accurately and completely.
4. Once called for an interview, the applicant must bring the originals of all documents attached.
5. All incomplete or inaccurately filled forms will be automatically rejected.
6. Copies of ALL DOCUMENTS required must be provided by the applicant. Any applications
without relevant documents will be rejected.
7. Canvassing will lead to automatic disqualification.
8. The completion and submission of this form is not a guarantee for sponsorship.
9. Any false statements, omissions or forged documents will lead to automatic disqualification.
10. Tower SACCO reserves the right to make the final determination of scholarship beneficiaries.
11. The KCPE score 350 marks and above.
12. Only 2023 KCPE candidates will be considered.
13. The application can also be submitted at your nearest branch or Head Office.
PART A: APPLICANT’S PERSONAL DETAILS
PERSONAL DATA Full Name of Applicant:
First/Baptismal: ____________________________ Middle: ___________________________
Surname/Family Name: ________________________________________________________
Gender: Male/ Female: _________________________________________________________
Date of Birth: _____________________________________ *(Attach copy of birth certificate)
Telephone/Mobile No_____________________ Alternative Mobile No.__________________
Physical Address:
County: _________________________________ Sub-County: ___________________________
Ward: __________________________________ Location: _______________________________
Sub-Location: ___________________________________________________________________
ACADEMIC INFORMATION
Name of Primary School Attended:
______________________________________________________________________________
Postal Address: P.O. Box: ____________________ Town/City: ____________________________
Postal Code: ______________________________ Telephone/Mobile No.___________________
Alternative Mobile No.____________________________________________________________
Physical Address:
County: ____________________________________ Sub-County: _________________________
Ward: _____________________________ Location _____________________________________
Sub-Location: _______________________
KCPE Index No: ___________________________ KCPE Marks: _____________________________
(Attach copy of results slip or one provided by the Head teacher of your former school with his/her
certification) Year sat for KCPE: _______________________________________________________
Have you attempted KCPE in previous years? Yes, or No ________ If yes, how many times? _______
why? _____________________________________________________________________________
Please indicate the KCPE scores attained for previous years: _________________________________
Have you repeated any class? (1-8) while in primary school Yes, or No_________________________
If yes which ones ___________________________________________________________________
Which Secondary school will you be joining?
______________________________________________
PART B: APPLICANT’S FAMILY INFORMATION PARENTS’ INFORMATION
Father’s Full Name: First Name: _______________________ Middle Name: ____________________
Surname: __________________________ ID No._________________________________________
Living: Deceased: ___________________________ [If deceased, please attach copy of death
Certificate/burial permit]
Physical Address: County: ____________________ Sub County: _____________________________
Ward: _____________________________ Location: ______________________________________
Sub-Location: ___________________________ Postal Address: P.O. Box: ______________________
Town/City: _____________________________Postal Code: _________________________________
Telephone/Mobile No. _______________________________________________________________
Source of Income: __________________________________________________________________
Mother’s Full Name : First Name: ______________________ Middle Name: ___________________
Surname: ____________________________ ID No:_______________________________________
Living/ Deceased: ___________________ [If deceased, please attach copy of death Certificate/burial
permit] Physical Address: County: ______________________ Sub-County:
___________________________
Ward: _____________________________ Location: _______________________________________
Sub-Location: ___________________________ Postal Address: P.O. Box: ______________________
Town/City: ______________________________Postal Code: ________________________________
Telephone/Mobile Number: __________________________________________________________
Source of Income: __________________________________________________________________
Are your parents living together? Yes, or No: _____________________________________________
GUARDIAN INFORMATION (If you are not living with the parents)
First Name: _____________________________ Middle Name: ______________________________
Surname: _______________________________ ID No: ____________________________________
Relationship with student/applicant: ___________________________________________________
Physical Address: County: _______________________ Sub-County: __________________________
Ward: _______________________________________ Location: ____________________________
Sub-Location: ___________________________ Postal Address: P.O. Box: ______________________
Town/City: ______________________________ Postal Code: _______________________________
Telephone/Mobile Number: __________________________________________________________
Source of Income: _________________________________________________________________
SIBLING INFORMATION
List all your brothers and sisters starting with the oldest and state what each one is doing. (If working,
describe job and monthly salary. If in university, state it. If in school, state the form or class. If in
training, describe it. If a sister is married, show the occupation of the husband. If a brother is married,
show the occupation of the wife).
NO. NAME AGE MARRIED/SINGLE SCHOOL/EMPLOYER CLASS/POSITION IN
EMPLOYMENT
1
2
3
4
5
6
7
8
9
10
PART C: APPLICANT’S EVIDENCE OF NEED APPLICANT’S INFORMATION
QUESTION ANSWER
Why are you applying for a scholarship?
Have you received any financial
support/bursaries in the past? Please provide
details:
Do you suffer from any physical impairment
(disability)? Do you have any disability or any
chronic illness? If yes, kindly describe and
provide evidence
Are you entitled to any form of inheritance
from your parents/ guardians/any other
source?
Who do you live with? Parent(s) / Guardian(s) /
Other Specify
Who do you live with? Parent(s)______________ Guardian(s)___________________________
Other Specify __________________________________________________________________
PARENTS’/GUARDIANS’ INFORMATION
QUESTION Father/Male Mother/Female Other
Guardian Guardian
Age of your
parents/guardians
Does any of your
parents have any form
of disability? Describe
the disability
Does any of your
parents/guardians
suffer from a chronic
disabling medical
condition? Describe
Are you living with
both parents? If not,
explain
Are your
parents/guardians
employed? Give
details of job and
salary per month:
Attach Pay slip
Do your parents/
guardians own a
business? Describe
and show the average
monthly income: Bank
Statement
Do your parents/guardians own land/plot? State Land size:
number of acres, type of crops grown, number
of cows/sheep/goats/donkeys and income from List livestock
such assets: Land size:
Do your parents/guardians have any other
assets or sources of income, including casual
labor? Indicate the approximate monthly income
FAMILY INFORMATION
QUESTION ANSWER
Has your family been affected by civil conflict or
natural disasters such as displacement, flooding,
drought, fire or famine? Describe
What type of house do you live in? Describe such
as grass thatched, iron sheet, cemented etc.
Please describe any other cause of disadvantage
or vulnerability?
Any sibling’s in
i) Secondary School:
ii) University:
SKETCH A DIRECTIONAL MAP TO THE HOME FROM THE NEAREST LANDMARK
PART 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 Tower SACCO Education committee or its representatives to obtain such
additional information concerning my educational program and financial records as needed to complete
this scholarship application. I also authorize Tower SACCO Education Committee and its representatives
to communicate and release information to others who are involved in making decisions relating to my
educational plans including and not limited to my previous and future schools, referees named in this
form and the Ministry of Education. In the event I win the scholarship, I commit myself to working hard
and posting excellent results throughout my secondary school course.
Signature: _____________________________________ Date: __________________________________
PARENT’S/GUARDIAN’S DECLARATION
I confirm that the above information is true to the best of my knowledge and I am aware that giving false
representation will mean that the application will not be considered and will lead to automatic
disqualification. On behalf of my child, I authorize Tower SACCO Education Committee or its
representatives to obtain such additional information concerning this applicant’s education and financial
records as needed to complete this scholarship application. I also authorize Tower SACCO Education
Committee and its representatives to communicate and release information to others who are involved
in making decisions relating to this applicant’s educational plans including and not limited to their previous
and future schools, referees named in this form and the Ministry of Education.
Parent/Guardian Name ____________________________________________________________
Signature: _____________________________________ Date: ______________________________
If you wish to provide additional information, please attach a separate piece of paper.
PART E: RECOMMENDATIONS
This part must be completed by the relevant authorities indicated. Any false information will lead to
disqualification.
Primary School Head Teacher:
Please report on the above named applicant’s performance, conduct, special interests and talents.
Also explain why he/she should be considered for the Education Scholarship
Program:__________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
How long have you known the candidate/family? ___________________________________________
My school has _____________ pupils who sat for KCPE and in the most recent tests sat by the applicant
before sitting for KCPE, this applicant’s position was no._________ overall and attained _____________
marks out of 500.
Report on any special interests or talents the child may have e.g. leadership, sports, arts, music etc.
__________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Rate the candidate’s financial ability: Very Rich___________ Rich__________ Middle Income________
Poor________ Very Poor________
I have reviewed the information given in this form and believe it to be truthful. The above named
student attended my school and based on my knowledge and/or inquiries, I affirm that he/she is
needy/vulnerable. Please describe facts about his/her circumstances.
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Name: _______________________________________________________________________________
Signature & Official Stamp: _________________________________ Date_________________________
Postal Address: P.O. Box: _________________________________ Town/City: _____________________
Postal Code: _____________________ Telephone/Mobile No.__________________________________
Provincial Administration (Chief or Assistant Chief).
How long have you known the candidate/family? ___________________________________________
Rate the candidate’s financial ability:
Very Rich_________ Rich _______ Middle Income________ Poor_________ Very Poor____________
YES NO
ORPHANED
PARENTS/GUARDIAN ARE
EMPLOYED
ANY ADDITIONAL
INFORMATION
I have reviewed the information given 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: ____________________ Telephone/Mobile Number: _______________________________
Religious Leader (Bishop, Pastor, Priest, Imam, etc.)
How long have you known the candidate/family? ___________________________________________
Rate the candidate’s financial ability: Very Rich_______ Rich________ Middle Income____________
Poor________ Very Poor___________
I have reviewed the information given in this form and believe it to be truthful. Based on my knowledge
and/or inquiries I affirm that this student is needy/vulnerable based on the following facts about his/her
circumstances.
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Name: _______________________________________________________________________________
Signature & Official Stamp: ______________________________ Date__________________________
Postal Address: P.O. Box: _____________________________ Town/City: _______________________
Postal Code: _____________________________ Telephone/Mobile Number: _____________________
NB: If a family is found to have misrepresented their circumstances, the scholarship will be
terminated and they will be required to refund fees paid.
