UNHCR SCHOLARSHIP FORM

Please Counter-Check the Details Before Clicking Print Form.
@if(!empty($details))
Telephone: +254-2-2725711/2/3/4
Fax: +254-2-2722907 Website:
www.kmtc.ac.ke Email:
admissions@kmtc.ac.ke


SRN:#{{Auth::User()->id}}

P.O Box 30195 00100,
Nairobi Kenya Telegrams.
“MEDTRAIN” Nairobi

KENYA MEDICAL TRAINING COLLEGE

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ISO 9001: 2008 Certified KCSE FULL INDEX NUMBER:  {{$indexnumber}}
APPLICATION FORM FOR PRE-SERVICE CANDIDATES
(CERTIFICATE IN COMMUNITY HEALTH NURSING 2023/2024 ACADEMIC YEAR)
APPLICATION FOR SCHOLARSHIP

Please complete this form ONLINE in BLOCK letters, print it out, sign and date it, and have it signed and stamped by the chief/Assistant chief and religious leader. Attach the following documents to the duly completed form and send it to the Director, KMTC P.O Box 30195 - 00100 Nairobi.

  1. National ID/Refugee ID OR registration Number /Birth Certificate/Waiting Card,
  2. Form 4 certificate/Result Slip,
  3. School leaving certificate,
  4. A handwritten essay of not more than two hundred (200) words explaining why you feel that you deserve the scholarship and the contribution you will make to the community upon graduation.
  5. National ID of mother and father if alive, OR if a refugee, a support letter from UNHCR OR Department of Refugee Services and
  6. Death certificate of mother and father if deceased
SECTION A: Applicant's Personal Particulars

i.Names as per ID/Passport/Birth Certificate {{strtoupper($details->first_name." ".$details->middle_name." ".$details->last_name)}}

ii.KCSE Full Index No: {{$indexnumber}} Year of Examination: {{$details->yearofexam}}

iii. Postal Address: {{$details->address}} PostalCode: {{$details->postal_code}} Town: {{$details->town}}

gender=="M"){ $details->gender="Male"; }else{ $details->gender="Female"; } ?>

iv.ID/Birth Cert. No/Waiting Card No /Refugee identification document {{$details->id_number}} Gender: {{$details->gender}}

vi. Name of Father/Guardian {{$details->father_name}} Tel. No: {{$details->father_telephone}} Status: {{$details->f_alive}}

vii. Name of Mother: {{$details->mother_name}} Tel. No: {{$details->mother_telephone}} Status: {{$details->m_alive}}

(If father/Mother is alive attach copies of national ID)

viii.Nationality: {{$details->citizenship}} County :{{$details->countyName}} Sub-County: {{$details->subName}} Constituency:{{$details->constname}} Tribe: {{$details->tribe}}

ix. Mobile telephone contact (Applicant)1: {{$details->phone}} Next of Kin(2) :{{$details->kname}} Alternative Phone :{{$details->ktel}}

SECTION B: Administrative and Religious background

i. Name of Assistant Chief/Camp Manager...........................................................Tel. No...................................Signature & Stamp..............................

Comments of the Assistant Chief on the suitability of the candidate for scholarship:




ii. Name of Religous Leader/Camp Manager/UNHCR..........................................................Tel. No.......................................Signature & Stamp.............................

Comments of the Religous Leader on the suitability of the candidate for scholarship:




SECTION C: Applicant’s Education Background

School attended: {{$details->school_attended}} Year of Examination:{{$details->yearofexam}}

SECTION D: Disability Assessment

disability=="No"){ $details->disability_type="N/A"; $details->disability_info="N/A"; } ?>

i. Do you consider yourself a person with disability?{{$details->disability}} Type/Class:{{$details->disability_type}}

(Please note that disability information is required for planning purposes and not criteria for selection)

ii.Give details of the nature of Disability:{{$details->disability_info}}

SECTION E: Applicant’s Declaration

I declare that the information given herein is true and accurate to the best of my knowledge and fully understand that any information found to be false will lead to automatic disqualification from consideration and/or prosecution.

Signature_____________________________ Date_______________________

@php echo strtoupper(" NB:By clicking Print Form You agree to the fact that the information supplied above are your true personal information.THIS IS THE FINAL STEP OF YOUR APPLICATION. TERMS AND CONDITIONS APPLY.") @endphp

id ?> Print Form
@else
{{-- You have not applied for Scholarship Program. Check Subject Score requirements and try again
N/B You must meet requirements to apply
--}}
@endif