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MUT/F/SWD/004
MURANG’A UNIVERSITY OF TECHNOLOGY
P.O. BOX 75-10200 MURANG’A, KENYA TELEPHONE 0771463515 / 0771370824
OFFICE OF THE DEAN OF STUDENTS
INSTRUCTIONS
WORK STUDY APPLICATION FORM
All students wishing to be considered for Work study MUST fulfill the following conditions:
1. Submit a duly filled Work study Application forms within the set timelines
2. Be enrolled into a full time Certificate, Diploma and Bachelors’ degree programme at
Murang’a University of Technology during any semester in which assistance is
received.
3. Demonstrate a genuine need of financial assistance
4. Have a record of sustained high academic achievement
5. Be a Kenyan citizen
6. Not have been found guilty of a disciplinary offence within the last one year
7. Provide written statements from two (2) referees who know their financial situation
well. One of the referees should be a member of the Provincial Administration
e.g., a local Chief, the other one a Priest or Kadhi and/or a lawyer. The statements
should be signed, stamped and submitted clearly indicating the name of the
applicant.
Important Note
Any student or person filling this Application form and knowingly gives false or misleading
information whether in writing or by attaching herein a false document(s) shall lead to
automatic disqualification and may be subjected to disciplinary action as per the rules and
regulations guiding student conduct.
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PART A: STUDENT DETAILS
i) Name: _______________________
Last First Middle
ii) Registration No.: ________________________________________________________
iii) Gender: Male Female
iv) Date of birth: __________________________________________________________
v) ID Number: (Attach copy)
vi) Programme of study: ____________________________________________________
vii) Sponsorship: Government Sponsored Self-sponsored
viii)Current mailing address: __________________________________________________
ix) Mobile No.: Alternate Mobile No.: ____________________
x) Disabilities: Physically challenged Visually challenged
Other (specify) ___________________________________________________
xi) Mean grade achieved in the preceding academic year or KSCE Mean grade and points
in case one is a first year: _________________________________________________
xii) Co-curricular activity(i.e.) in the University
______________________________________________________________________
PART B: PARENTS DETAILS
Family category (tick the category that describes your family)
Orphaned single parent/guardian/sponsor more than one parent /guardian
1. FATHER 2. MOTHER
a) Father Alive Deceased a) Mother Alive Deceased
b) If deceased, provide the date of death; b) If deceased, provide the date of death;
(Attach death certificate if available) (Attach death certificate if available)
c) If alive give his age; c) If alive give her age;
d) Name: ID/No. d) Name: ID/No.
e) Occupation: e) Occupation;
f) Name and address of employer (s) f) Name and address of employer(s)
________________________________________
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g) If retired give name (s) and address of last g) If retired give name (s) and address of last
employer (s); employer(s);
Year of retirement: Year of retirement:
PART C: GUARDIAN/SPONSOR DETAILS
a) Name: b) Mobile No.:
c) ID/No.: d) Occupation:
e) Name and address of employer:
PART D: FINANCIAL INFORMATION
NOTE: Due to the large number of students interested in financial assistance
at the University, consideration will only be limited to students that demonstrate
genuine financial difficulties and will be subject to the availability of funds.
a) Gross family income in the last 12months
ITEM FATHER MOTHER GUARDIAN/ SELF TOTAL
SPONSOR (KSHS)
Gross income from employment
(Salary or Pension)
Income from Business e.g., Shop,
Hotel, Matatu, etc.
Income from farming e.g., Crops,
Livestock, Fishing, etc.
Income from other sources e.g.,
Shares, Dividends, Interest
TOTAL
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b) Other sources of income in the last 12months
ITEM TOTAL (KSHS)
HELB
County
CDF
Fund Raising
Donations
Any other (State Name)
GRAND TOTAL
c) Fee payment at MUT
(i) Current payable fees/semester: Kshs ____________________
(ii) Current average expenditure/semester: Kshs ______________
(iii) Current fee balance: Kshs _____________________________
d) Applicant’s Siblings in Educational Institutions (Please attach documentary
evidence)
CHILD’S NAME INSTITUTION NAME YEAR OF COST OF EDUCATION
STUDY (for the
last one year)
1.
2.
3.
4.
5.
6.
TOTAL
Number and age(s) of siblings not in school
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PART E: ELIGIBILITY FOR WORK STUDY
Please explain why you consider yourself eligible for MUT work study and why you should be
considered for an award:
PART F: REFEREE STATEMENTS:
Please provide the names and contact details of two (2) referees who know you well and can
provide an honest and comprehensive reference regarding your financial situation. One of
the referees should be a member of the provincial administration e.g., a chief, the
other one a priest or Kadhi. It is your responsibility to ask them to forward their support
and comments to the Students’ Welfare Committee through the Office of the Dean of
Students before you submit this form.
Referee details (Name, Phone, E-mail address):
1. _________________________________________________________________________
_________________________________________________________________________
2. _________________________________________________________________________
_________________________________________________________________________
PART G: DECLARATION
I hereby apply for work study for the
Academic Year. The above information is complete and
accurate to the best of my knowledge. I am aware my eligibility for the work study may be
withdrawn based on any changes to my enrolment status, academic standing or found to have
committed a disciplinary offense.
Applicant’s Signature Date: ______________________
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OFFICIAL USE ONLY
Receiving Officer: _________________________________________________________
Date and Stamp: ___________________________________________________________
Recommendation work study of the Committee
a) Recommended for Work study: ____________
b) Not Recommended Work study ____________
Work study Amount awarded (where applicable) (Kshs)
Signature: Date and stamp: ____________________
Chairman Students Work Study Committee
This form should be forwarded to: The Dean of Students, Murang’a University of
Technology. P.O. Box 75-10200 Murang’a, Kenya. Telephone No. 0743540295
