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Merit Based Form - 2024

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jumagaya6
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35 views4 pages

Merit Based Form - 2024

Uploaded by

jumagaya6
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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MERIT-BASED SCHOLARSHIP APPLICATION FORM

LEARNER’S DETAILS ----------------------------------------------------------------------------------


Names: __________________________________________________________________
Surname First name Second name

Date of birth: _______________________ Nationality: _____________________________

Gender: _________________________ Other Languages Spoken: ____________________

Religion: ________________________

ACADEMIC INFORMATION ------------------------------------------------------------------------------------------


Current school: _________________________________________
Principal: _________________________________________
School address: _________________________________________
School telephone: _________________________________________
School Email: _________________________________________
Learner’s current Grade: _________________________________________
Date of admission to current school: _________________________________________
Names of previous schools: 1) ________________________________________
2) _________________________________________
3) _________________________________________
Annual fees currently paid: _________________________________________
Any other fees paid: ___________________________________________

FAMILY DETAILS --------------------------------------------------------------------------------------------------------


Father / Guardian Mother / Guardian
Surname: _____________________ ________________________
First Names: _____________________ ________________________
Date of Birth: _____________________ ________________________
Occupation / Profession: _____________________ ________________________
ID / Passport number: _____________________ ________________________
Nationality: _____________________ ________________________
Residential address: _____________________ ________________________
Postal Address: _____________________ ________________________
Mobile No: _____________________ ________________________
E-mail: _____________________ _______________________

The Jain Education Fund is under the auspices of the Shree Jain Shvetamber Derawasi Sangh Mombasa
the
SIBLING DETAILS -------------------------------------------------------------------------------------------------------
1 2 3 4
NAME

CURRENT SCHOOL

GRADE

ANNUAL FEES

PERSON
RESPONSIBLE FOR
PAYING FEES

DATE OF ADMISSION
TO CURRENT
SCHOOL

NAMES OF 1) 1) 1) 1)
PREVIOUS
SCHOOLS
2) 2) 2) 2)

3) 3) 3) 3)

(IF MORE ADD ON EXTRA SHEET)

Academic Achievements of the Learner:


Provide any details of academic achievements not included in accompanying reports e.g.prizes,
awards etc.
_____________________________________________________________________________

_____________________________________________________________________________

Cultural Activities
Music, Drama, Art etc. Please specify details e.g. Music Grade 3
_________________________________________________________________________

_____________________________________________________________________________

Sports
Teams represented personal achievements etc.
_____________________________________________________________________________

_____________________________________________________________________________

Other areas of interest and achievements


_____________________________________________________________________________

_____________________________________________________________________________

The Jain Education Fund is under the auspices of the Shree Jain Shvetamber Derawasi Sangh Mombasa
Where did you find out about this scholarship?

FINANCIAL DETAILS ---------------------------------------------------------------------------------------------------


Father / Guardian Mother / Guardian
Gross Monthly Income __________________ __________________
Any other income e.g. Rent, allowances __________________ __________________
Electricity Bill Average for last 3 months __________________ __________________

FURTHER ASSETS -----------------------------------------------------------------------------------


Own Car (est. value):_____________ Brand/Model: ______________ No. Plate______________
House: Rented (Rent amount) ______________ Owned (Est Value) _________________

Any Other assets: _______________________________________________________________

PLEASE SUBMIT THE FOLLOWING DOCUMENTATION TOGETHER WITH THIS APPLICATION:


• Application form duly signed
• Colour passport-sized photograph of learner
• Copies of last 2 academic years’ school reports
• Copy of birth certificate of learner
• Copy of parents and/or guardians ID or Passport
• Payslip copies (6 months) for both parents and/or guardians
• Electricity Bill Copies for last three months
• Copy of Current ITAX return
• Any other documents to support your application

DECLARATION ---------------------------------------------------------------------------------------
By appending our signature on this form, we confirm that the information provided is a true and an accurate
reflection of our identification and financial situation to the best of our knowledge. Any information that is
found to be incorrect or invalid will lead to the withdrawal of the scholarship. In addition, any changes in our
financial situation as captured above will be relayed to the school administration immediately.

Completing this application may not necessarily result in approval of the scholarship.

SIGNATURE FATHER/ GUARDIAN DATE

SIGNATURE MOTHER/ GUARDIAN DATE

The Jain Education Fund is under the auspices of the Shree Jain Shvetamber Derawasi Sangh Mombasa
OFFICIAL USE ------------------------------------------------------------------------------------------------------------
Principal’s comment:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Application Reviewed by:

Name:_________________________Signature:_________________Date:_________________
Name:_________________________Signature:_________________Date:_________________
Proceed to Written assessment: Approved Rejected

Written Assessment Results:

1. Maths ________________________
2. English _______________________
3. Science_______________________
Oral Presentation:
Topic: _______________________________________________________________________
Assessed by: Name_______________________ Sign________________ Date_____________
Assessor’s Comments:
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
Demonstration of Talent:
Talent Description: ______________________________________________________________
Assessed by: Name________________________ Sign________________ Date_____________
Assessor’s Comments:
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Application Final Decision: Approved % Awarded_______ Rejected

Final Decision Comments:


_____________________________________________________________________________
_____________________________________________________________________________
Decision Reviewed by:
Name:_________________________Signature:_________________Date:_________________
Name:_________________________Signature:_________________Date:_________________

The Jain Education Fund is under the auspices of the Shree Jain Shvetamber Derawasi Sangh Mombasa

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