Please paste recent

passport photograph. Do
attach and submit two
copies in an envelope
SCHOLARSHIP APPLICATION FORM – COHORT SIX ACADEMIC YEAR 2020/2021

Makerere University in partnership with Mastercard Foundation is implementing a Scholars Program to enable
academically talented yet economically disadvantaged youth from Africa access quality undergraduate education.
Only students admitted to Makerere University main campus from the categories specified in the advertisement are
eligible to apply. A completed form should be submitted to Senate Building Level 4, Room 402 or sent through the
following email addresses [email protected] or [email protected] Only short-listed candidates
will be contacted to appear for interview. Note that the application form is NOT FOR SALE and NO PAYMENTS
should be made by the applicant at any stage of the selection process. The deadline for submission is Friday 15th
May 2020 at 5.00 pm. Applicants are advised to read the application guidelines below before filling in the form.

ELIGIBILITY:

The applicant
a) Only youth in the categories below qualify to apply:
i. Refugees living in Uganda
ii. Internally displaced youth
iii. Students who completed the Uganda Advanced Certificate of Education (UACE) from schools located
in Northern Uganda.
iv. Students who completed the Uganda Advanced Certificate of Education (UACE) from schools located
in Eastern Uganda.
b) Must have completed A level studies in 2018 or 2019 and must not be a registered student of any other
University/Institution.
c) Must be admitted on private scheme to study at Makerere University main campus in the academic year
2020/2021. This means that in order to fit within the admission guidelines, all Scholarship applicants should
endeavor to apply for admission when Makerere University advertises for private sponsorship.
d) Must be from an economically disadvantaged background.
e) Should exhibit academic excellence in either Sciences or Arts with a minimum of 11 points for young
women and 13 Points for young men obtained in Uganda Advanced Certificate of Education (UACE) or its
equivalent obtained in 2018 and 2019.
f) Must demonstrate leadership potential and have a record of community service.
g) Should not be a holder of any other Scholarship.

COMPLETING THE APPLICATION FORM

A completed application should include the following:

a) Three Passport size photographs with the applicant’s name written at the back in block letters. (Paste one on
the form and two should be submitted in an envelope).
b) A copy of the applicant’s Birth Certificate.
c) A copy of Refugee Identity document where applicable
d) A copy of the academic documents including Primary Leaving Examination, Ordinary Level, and Advanced
Level Certificates.
e) Photocopies of Advanced Secondary Level bank slips.
f) Copies of death certificate(s) of biological parent (s) (if applicable).

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 g) Copies of result slip for term one and two of senior six
h) Hand drawn physical map of LC I /Village of residence with clear directions of how to get to the home of
residence (indicate approximate distances in kilometers from the main road).
i) Endorsement by the Head Teacher of the A-level School attended in Section G (signed and stamped).
j) Endorsement by the LC 1 of the District of Residence in Section H (signed and stamped)
k) Recommendation from the former sponsoring organization

OCCUPATION OF THE PARENTS OR GUARDIAN

This information must be as detailed as possible. Scanty information will be a disadvantage to your candidature. The
following categories are given as a guide but are not exhaustive.

1. If your father/mother/guardian is or was a businessperson, describe the business e.g. if he/she is a hawker, petty
trader, retail trader, wholesaler or manufacturer, describe the categories of the goods he/she trades in. In addition,
give the physical address of the business.
2. If your father /mother/guardian is an employee, state the position held and the organization/Ministry and the
corresponding salary scale.
3. If your father/mother/guardian is or was a farmer, state whether he/she is or was a subsistence farmer,
mixed/integrated/semi-commercial or commercial farmer and the type of farming i.e. whether it is keeping livestock
or growing crops or a combination of both. In addition, you should estimate the number of acres on which the
farming is done.

NOTE:

a) Whereas both male and female applicants are eligible, female applicants will be given priority.
b) Incomplete application forms will be automatically disqualified
c) All applicants or those who will submit the application form should ensure that they register in the book.
d) Applications slipped under the doors of any office will NOT be accepted.
e) This program exercises merit principles and zero tolerance to dishonesty. Any form of influence pedaling by
anybody will lead to automatic disqualification of the applicant.
f) Cases of impersonation, falsification of documents or giving false / incomplete information, whenever
discovered either at the time of receiving the award or afterwards will lead to automatic cancellation of the
award, refund of the money already spent on a beneficiary / prosecution in the courts of law of Uganda.
g) Filling in and submitting an application form does not guarantee one a scholarship.
h) Makerere University appeals to the public to be aware of fraudsters within or outside of the University, who
might want to take advantage of the scholarship application process by way of selling scholarship forms or
soliciting for money in the hope of securing an applicant a scholarship. Mastercard Foundation Scholarship
application form is free of charge; individuals caught in the act of conning the public will be prosecuted in
courts of law.
i) While the scholarship is a preserve of students admitted to Makerere University, the Scholarship
Coordination Office is not responsible for the requirements for admission into Makerere University. All
potential Scholarship applicants should meet the necessary requirements to be admitted into the University
on the private sponsorship scheme.
j) Only successful applicants will be notified at every stage of the scholarship application process, and the
decision of the Selection Committee will be final in the awarding of the scholarship.
k) Those applicants who will not have heard from us by 28th August, 2020 should consider their application
unsuccessful.

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To be filled by applicant (Incomplete applications will not be considered)

Section A. Personal Information of Applicant

A1 Surname (Block letters)

A2 First Name

A3 Middle name (if any)

A4 Date of Birth (dd/mm/yyyy)

(Attach a photocopy of a birth
certificate)
Age:

A5 Sex Male Female

A6 Place of Birth: District/State Country of Birth Nationality

A7 Village Sub-county
Current Contact Address
District of residence1 Country

A8 Name the nearest main road Draw a sketch map of how one gets to your current residence on Page 11.
from the district town to your
residence

A9 Give a distinctive feature to

your residence

A10 Home Country and District if

different from current
residence

A11 Specify under which category i. Refugees living in Uganda

you are applying (circle the ii. Internally displaced youth
appropriate) iii. Students who studied in secondary schools located in Northern Uganda.
iv. Students who studied in secondary schools located in Eastern Uganda.

NOTE: Refugee applicants should attach a copy of their refugee ID

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Residence is the main place where the applicant has been living for the past two to five years

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B: Contact Information

B1 Applicant’s telephone number

B2 Permanent email address
B3 Guardian’s name and
telephone number
B4 Mother’s name and telephone
number
B5 Father’s name and telephone
number

School Contact Information

B6 Former School email address

B7 Former School telephone

number(s)

Other Contacts
Other contact person likely to
B8 know how to reach the
applicant in the future
B9 Relationship to applicant:

B10 Country of residence:

B11 Contact email address:

B12 Contact Phone(s)

Section C. Academic Information

Examination Year of State the Overall State the location of the Type of
undertaking name of score or School by region i.e School (i.e
this exam the School grade point Western, Northern, private,
Central or Eastern region. USE, Gov’t)
C1 UACE/its equivalent
(Attach a photocopy of
result slip/certificate
and Identity Card) In
addition, provide copies
of academic reports for
term 1 and 2 of senior
six.

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Examination Year of State the Overall State the location of the Type of
undertaking name of score or School by region i.e School (i.e
this exam the School grade point Western, Northern, private,
Central or Eastern region. USE, Gov’t)
C2 UCE/its equivalent
(Attach a photocopy of
a result slip/certificate)

C3 PLE (Attach a
photocopy of result
slip/certificate)

C4 Amount of fees paid at Senior 6 TERM I TERM II TERM III

each level PER TERM
(Attach a photocopy
of school fees bank
lip/School pay slip Senior 4 TERM I TERM II TERM III

C5 Indicate the subjects Subjects Letter Grade Grade Points

offered at A level and
the grades obtained in 1.
each
2.

3.

4.

5. General Paper

Total

Section D: Family Background

Please indicate details of your parents in this section
Particular Father Mother
D1 Name
D2 Status (indicate whether alive or deceased) and
provide copies of death certificate/s if applicable
D3 Age of parents if alive
D4 District of residence
D5 Occupation/job tittle now or previously
D7 State total income per year
D8 Organization/place of work
D9 Highest level of education
D10 If deceased in NO. D1 above, state the name of the
guardian
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 Particular Father Mother
D11 State the relationship with guardian
D12 Guardians occupation/source of income
D13 Who is the head of your house hold
D14 State the Head of Household income per year

D15. Occupational Status of head of household:

Employee - Full-Time Employment Retired - With Pension

Employee - Part-Time Employment Retired - Without Pension

Self-Employed - With Employees Not Employed

Self-Employed - Without Employees

Siblings and Dependants living in the household

D16 Number of siblings
D17 Number of
dependants
D18 Please provide detailed information about your brothers/sisters from your parents who are either out of
school or still in school
Name Age Current level Name of institution occupation/source of income
of education where they are
currently
studying/working
1
2
3
4
5
6
7
8
9
10
D19 Please provide detailed information about dependants in the household
Name age Current level of Name of institution/ where Occupation/sour
education they are currently ce of income
studying/working

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1
2
3
4
5
6
7
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D20 Total Number of people living in household including
the applicant:
D21 Does the household have electricity?
D22 State the type of roofing material

D23. Who paid for previous schooling? (check all that apply):

Employer Scholarship (Attach recommendation from the

sponsor)

Guardian(s) Self

Guardian(s) not related to Sibling(s)

scholar

Other Relative(s) Sponsor(s)

Parent(s) Other
If ‘Other’, please state who paid fees …………………………………………………………………….……………..

E: Section E: Leadership Experience

E1 Describe previously held leadership position,

activities, or experiences: (i.e. positions where
the scholar has guided or led a group of people, a
project, or a cause) Please attach a certificate(s)

E2 State any Awards and Honors received: (i.e.,

secondary school citizenship award; president's
medal for outstanding leadership, etc.

E3. Participation in extracurricular activities:

Sports: State role Community services: State role

Religious Groups: State role Local organizations: State role

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 School Clubs: State role Peer-to-peer groups: State role

Other
E4. If Other, Explain …………………………………………………………………………………………………..…
E5. If you have been a member of a team, club, organization, or association, State your role:
………………………………………………………………………………………………………………………...…
E6. If you have previous work experience, please provide a short explanation of this experience

……………………………………………………………………………………………………………………………

……………………………………………………………………………………………………………………………

Section F: Community Service Experience

F1 Have you ever engaged in any voluntary

activity (Yes or NO)

F1 If the answer is yes. Describe your voluntary

activities and experiences

F3 Describe your aspirations for social change and

F4 How do you plan to achieve social change

through your career

F4. Which sectors do you plan to impact through your social change aspirations?

Agriculture Information Technology

Skilled Trades Public Service / Government

Small Business / Entrepreneurial Religious

Social & Humanitarian services Education

Health & Medical Other

If ‘Other’ please explain ……………………………………………………………………………….……………….
F5. Which sectors do you plan to impact through your career aspirations?

Agriculture Information Technology

Skilled Trades Public Service / Government

Small Business / Entrepreneurial Religious

Social & Humanitarian services Education

Health & Medical Other

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If ‘Other’ please explain ……………………………………………………………………………………….……….

F6 Do you have any form of Yes No

disability?

F7 If yes, what form of disability?

Attach your full photograph.

F8 How did you get to know about the scholarship opportunity?

Radio Newspaper Poster MCF Staff

Former School Friend/word of mouth Website

Others, specify

F9 What career do you plan to

pursue? (I.e. Doctor,
Humanitarian Relief Worker,
Entrepreneur, Teacher, etc.)
I declare that all the information provided here is true and accurate to the best of my knowledge,
and I have read and understood the note to applicants below.

Applicant: Parent/guardian:

Name: Name:
_________________________________________ _________________________________________

Signature and Date: Signature and Date: _______________/_____/2020

______________________/_____/2020

SECTION G: TO BE COMPLETEBY THE HEAD TEACHER OF YOUR FORMER ADVANCED LEVEL

SECONDARY SCHOOL

Please provide your assessment (to the best of your knowledge) about the applicant on:

a) Conduct /Behaviour

Excellent Very good Good Fair Poor

Please explain your assessment

……………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………

b) Financial ability

Rich Middle-class Needy Very needy

Please explain your assessment

……………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………
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Name and Signature of Head Teacher (with date and stamp)

Name: ____________________________________ Signature ________________________ Stamp

Mobile No. ___________________________________Date:_______________/_________________/__________

Comments on applicant’s previous sponsorship:

……………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………

H: TO BE COMPLETED BY LOCAL COUNCIL 1 OFFICIALS FROM THE DISTRICT OF RESIDENCE

VERIFICATION OF THE APPLICATION

LC I Chairperson
a) Surname_______________________________________________Other name(s) _________________________
b) Village (LCI) ____________Parish ______________Sub-County_________________ District _____________
c) Does the applicant reside in this village? Yes/No______________________ If yes, for how long______________
d) For how long have you known the applicant? _______________________________________________________
e) What is the applicants’ district of origin? __________________________________________________________
f) How many biological children are in her/his family? ___________________ How many are independent or
working? ________________
g) What does/ did the father do to earn a living?
______________________________________________________________________________________________
h) What does/did the mother do to earn a living? _______________________________________________________
i) Who was paying the applicants’ fees at secondary school level?
______________________________________________________________________________________________
j) Any other important information?
______________________________________________________________________________________________
k) RECOMMENDATION : Strongly Recommended Recommended Not Recommended

State the reason(s) for your recommendation__________________________________________________________

______________________________________________________________________________________________
______________________________________________________________________________________________
DECLARATION
I, the undersigned, hereby declare that I have carefully checked and verified the particulars stated above and certify
that they are true and accurate.
Name____________________________Signature_________________________ Stamp and Date

Telephone Number: ____________________________________________

‘Please note that submission of the application form does not guarantee getting the scholarship’

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Please draw a sketch map to your residence from the nearest main road and or trading center

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