Education to take you places

THE MASTERCARD FOUNDATION SCHOLARS PROGRAM

AT UNITED STATES INTERNATIONAL UNIVERSITY-AFRICA (USIU-AFRICA)

Dear Applicant,

USIU-Africa appreciates your interest in the Scholars Program made possible by the partnership
of Mastercard Foundation and USIU-Africa. By completing this application, you are taking the
first step in a process that will allow us to learn more about you, your achievements, and
your goals as a potential Scholar of this Program. We encourage you to read the application
guidelines before filling the form. The application form is NOT FOR SALE and NO PAYMENT
IS REQUIRED.

Completed application and supporting documents should be sent to [email protected]

by Friday, November 27, 2020. Our selection committee will review all applications carefully on
a continuous basis and nominate finalists by the deadline. All finalists will be interviewed either
in person or by phone in January 18 -29, 2021. Communications with the selected Scholars will
be done from February 15– 17, 2021.

A completed application should include the following:

1. Application letter stating the following:
a) Personal Background including family financial position.
b) Why you chose USIU-Africa.
c) Where you see yourself after graduation.
2. Copies of academic documents (High school certificates);
3. Recommendation from your former sponsoring organization, a Head Teacher or Career
advisor who has known you for at least two years;
4. One recent Passport size photograph;
5. A copy of your Birth certificate, National Identity Card or Passport and/or refugee travel
document;
6. A copy of refugee identity document (where applicable).

Please note that we will NOT evaluate INCOMPLETE applications.

Complete applications should be delivered/emailed only ONCE. Duplicate applications or

several emails from the same person will lead to disqualification of the applicant.

DEADLINE:
All applications must be received by Friday, November 27, 2020. We strongly encourage earlier
submissions.

State the degree program you are applying for____________________________________

Mastercard Foundation Scholars Program at USIU-Africa Application 2020

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 Education to take you places

A: PERSONAL INFORMATION
Please enter your name and all information as it appears on official documents such as an
identification card, birth certificate, or passport.

Surname (Family Name):___________________________________________________________________

First Names (Given Names):_________________________________________________________________

Gender: F M Nationality:__________________________ Birth Date:______/_______/__________
Day Month Year
Age (at the time of application):___________ Country of birth:___________________________________

Country of citizenship:_______________________ Country of residence:__________________________

Place of residence (at the time of application): Urban ________Rural _________Peri-urban__________

Do you have a passport? Yes No *Passport #:______________________________________

*If you have a passport, please attach a copy of it to this application.

Passport Issued by (Country):_______________________________________________________________

Your Email Address:________________________________________________________________________

Mobile Phone (Including Country Code): _____________________________________________________

Permanent Physical Address:_______________________________________________________________

Primary language spoken: _____________________________________________________________

Other languages: _____________________________________________________________________

B: CATEGORY OF SCHOLARSHIP
Please tick from the list below the category of scholarship you are applying for.
Young Women
Young Men
Refugee youth
Internally displaced youth
Youth with disability
How did you learn about the scholarship___________________________________________________

For refugees kindly provide the following information:

1. Refugee status: ____________________________________________________________________
2. UNHCR Number: ___________________________________________________________________
3. Do you live in a camp or as an integrated refugee: ______________________________________
4. If camp, please name the camp:______________________________________________________
5. If integrated, please give details of residence and contact details of persons responsible for
your integration. ____________________________________________________________________
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 Education to take you places

For Internally Displaced Youth, Kindly provide the following:

1. Letter from relevant government authority stating reason and nature of displacement.

For persons with disability, kindly provide the following information:

1. Nature of disability:__________________________________________________________________
2. Are you registered with any disability organizations? Yes No If yes which one? ______
___________________________________________________________________________________
3. Please indicate any special accommodation needs that you may require __________________
___________________________________________________________________________________

C. ACADEMIC INFORMATION

Name of High/ Secondary School:__________________________________________________________

Physical Address:(Location) ________________________________________________________________
Date of Graduation:_______________________________________________________________________
High/Secondary school exam system (e.g WAEC, IGCSE, KCSE, etc) Grade (s) Obtained__________
_________________________________________________________________________________________

School Type (mark all that apply): Government/Public Independent/Private

Religious Boarding

List all other Institutions (Tertiary – Universities or colleges) and any other academic programs

you have attended.

Level Dates Attended Name of Sponsor (if any) Qualification or

institution Grade Obtained
University

College

Others

Who paid for previous education?

Guardian (s) related to applicant
Guardian (s) not related to applicant

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 Education to take you places

Parent
Scholarship (attach recommendation letter from sponsor)
Self
Sibling (s)
Sponsor (s)
Other

If other; state who paid fees:________________________________________________________________

Applicant Name:_______________________________ Phone/Email:__________________________

D. FAMILY INFORMATION (Contact person in case of emergency)

Section 1: Parents or Guardians

Parent/Guardian #1

Surname:_________________________________________________________________________________

First Names (Given Names):_________________________________________________________________

Relation to you:_______________________________ Occupation:_________________________________

Highest Level of Education Attained:_________________________________________________________

Mobile Phone:______________________________________Email:_________________________________

Country of Residence:_________________________ Physical Address:____________________________

Parent/Guardian #2

Surname: ________________________________________________________________________________

First Names (Given Names):_________________________________________________________________

Relation to you:_______________________________ Occupation:_________________________________

Highest Level of Education Attained:_________________________________________________________

Mobile Phone:______________________________________Email:_________________________________

Country of Residence:__________________________Physical Address:____________________________

Primary language spoken at home:__________________________________________________________

Other Languages:_________________________________________________________________________

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 Education to take you places

Section 2: Siblings: Please list the Names, Level of Education, genders and ages of any brothers/
sisters you have, even if they don’t live in your household. If you need more lines please attach a
separate page at the end.

Full Name Gender Age Highest level of Occupation

(M/F) education/ degree
attained

Applicant Name: __________________________________ Signature____________________________

E. SHORT ANSWER QUESTIONS

LEADERSHIP EXPERIENCE (300 words maximum)

1. Describe a previously held leadership position, activities, or experiences: (i.e. positions

where you guided or led a group of people, a project, or a cause in which you were involved)

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 Education to take you places

2. State any Awards and Honors received: (i.e., academic award; Outstanding leadership award,
Community service award etc.

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3. What are you passionate about, what do you love to do and why? (300 words maximum )

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Applicant Name:______________________________ Phone/Email:______________________________

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 Education to take you places

F. COMMUNITY ENGAGEMENT
The Mastercard Foundation Scholars Program vision is that Scholars will use their education
to create change and improve the lives of others. (500 words maximum)
- Have you ever engaged in any voluntary activity (Yes or NO)
- If the answer is yes, describe your voluntary activities and experiences.
- Describe your aspirations for social change and how you plan to achieve social change through
your career.

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Applicant Name:______________________________ Phone/Email:______________________________

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 Education to take you places

G. ACTIVITIES
Please list up to three of the most important activities in each category (in order of importance
to you) that you have participated in during the past three years, either through your secondary
school or independently/in your community. Complete only the sections relevant to you.

School and Community Service:

Activity Role Number of years
Example: Student Government
1.
2.
3.
Employment/Entrepreneurial Enterprises:
Activity Role Number of years
1.
2.
3.
Competitions/Conferences/Special Programs:
Activity Role Number of years
1.
2.
3.
Artistic/Musical:
Activity Role Number of years
1.
2.
3.
Athletics:
Activity Role Number of years
1.
2.
3.

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 Education to take you places

H. CERTIFICATION PAGE

I,___________________________________________________________hereby certify that all information

contained in this application is truthfully and accurately presented and as my work alone and give
my permission to USIU-Africa to obtain any verification deemed necessary to process my
application. Finally, I acknowledge that completing this application form does not guarantee
scholarship.

Signature:_____________________________________________Date:_____________________________

CONTACT DETAILS
Mastercard Foundation Scholars Program
United States International University-Africa
P.O. Box 14634 00800
Nairobi
Tel: +254 730 116 218
E-mail: [email protected]

Mastercard Foundation Scholars Program at USIU-Africa Application 2020