Name of student (surname first)
Current class
Year of admission
Expected year of graduation
Gender MaleFemale
Name of contact person Phone number Have you been a beneficiary of the bursary scheme? YesNo 2023/2024 academic session 3rd term result Student Current School Identity Card
Name of father
Father's family
Maiden Name of mother and family name of Mother, if father is not from Ikuru-Town
Family
Is your father a native of Ikuru Town? YesNo
Is your mother a native of Ikuru Town? YesNo
Account name
Account number
Bank
I,
hereby declare that the above information given by me are correct, any false declaration stated herein will lead to the disqualification of my application.
Upload a passport -type photograph
