Equity wings to fly 2021 application form
The Equity Wings to Fly scholarship is now available for the KCPE 2020/2021 candidates who will join form one this year. Get all the details on how to apply plus requirements here. Download the application form here (check towards end of this page).
THE EQUITY WINGS TO FLY APPLICATION FORM 2021
FORM A: APPLICATION FORM
(2021)
Branch _____________________________
WINGS TO FLY SECONDARY SCHOOL SCHOLARSHIP PROGRAM
INSTRUCTIONS/GUIDELINES
- This form is given FREE OF CHARGE by the Equity Group Foundation
- The information provided in this form is intended to help the Equity Group Foundation Community Scholarship Selection Board understand the applicant’s academic and financial position for the purpose of assessment for scholarship/award
- This application form must be filled accurately and completely in CAPITAL LETTERS
- On being called for an interview, the applicant must bring the originals of all documents attached
- All incomplete or inaccurately filled forms will be automatically rejected
- Copies of ALL DOCUMENTS required must be provided by the applicant. Any applications without relevant documents will be rejected
- Canvassing will lead to automatic disqualification
- The completion and submission of this form is not a guarantee for sponsorship
- Any false statements, omissions or forged documents will lead to automatic disqualification
- Equity Group Foundation reserves the right to make the final determination of scholarship beneficiaries
- Only 2021 KCPE candidates will be considered
- The application can also be submitted through the Wings to Fly online platform https://egfdmis.equitybank.co.ke/register_w2f
- Every part of this form must be filled. Failure to do so makes this application form incomplete and therefore renders the applicant illegible for the scholarship
PART A: APPLICANT’S PERSONAL DETAILS
PERSONAL DATA
Full Name of Applicant:
First/Baptismal: _________________________ Middle:__________________ Surname/Family Name: _______________________
Gender: Male Female Date of Birth: D D M M Y Y Y Y
*(Attach copy of birth certificate)
Telephone/Mobile No. Alternative Mobile No.
Physical Address: County :_________________________________ Sub-County: __________________________________________
Ward: __________________________________ Location: ______________________ Sub-Location: ________________________
ACADEMIC INFORMATION
Name of Primary School Attended: ________________________________________________________________________
Postal Address: P.O. Box: Town/City: Postal Code:
Telelephone/Mobile No. Alternative Mobile No.
Physical Address: County: ____________________________________ Sub-County: ______________________________________
Ward: _____________________________ Location _____________________________ Sub-Location: _______________________
KCPE Index No. KCPE Marks:
(Attach copy of results slip or one provided by the Headteacher of your former school with his/her certification)
Year sat for KCPE: ________________ Have you attempted KCPE in previous years? Yes n No. If yes, how many times and why? ______________________ Please indicate the KCPE scores attained for previous years: _______
Have you repeated any class? (1-8) while in primary school Yes n No n If yes which ones ____________________________
PART B: APPLICANT’S FAMILY INFORMATION
PARENTS’ INFORMATION
Father’s Full Name:
First Name:__________________________ Middle Name:_________________________ Surname: __________________________
ID No. Living: Deceased: [If deceased, please attach copy of death/burial certificate]
Physical Address: County: ____________________________________ Sub-County:_______________________________________
Ward: _____________________________ Location: _________________________ Sub-Location: ___________________________
Postal Address: P.O. Box: Town/City: Postal Code:
Telephone/Mobile No.
Source of Income: ________________________________________________________________________
Mother’s Full Name :
First Name: ________________________ Middle Name: ________________________ Surname: ____________________________
ID No. Living: Deceased: [If deceased, please attach copy of death/burial certificate]
Physical Address: County: __________________________________________ Sub-County: _________________________________
Ward: _____________________________ Location: _________________________ Sub-Location: ___________________________
Postal Address: P.O. Box: Town/City: Postal Code:
Telephone/Mobile Number:
Source of Income: ________________________________________________________________________
Are your parents living together? Yes n No n
GUARDIAN INFORMATION (If not living with the parents)
First Name: _____________________________ Middle Name:_____________________ Surname :__________________________
ID No. Relationship with student/applicant:_______________________________________
Physical Address: County: __________________________________________ Sub-County: _________________________________
Ward: _____________________________ Location: _________________________ Sub-Location: ___________________________
Postal Address: P.O. Box: Town/City: Postal Code:
Telephone/Mobile Number:
Source of Income: ________________________________________________________________________
SIBLING INFORMATION
List all your brothers and sisters starting with the oldest and state what each one is doing. (If working, describe job and monthly salary. If in university, state it. If in school, state the form or class. If in training, describe it. If a sister is married, show the occupation of the husband. If a brother is married, show the occupation of the wife).
Name Age School/Employer Class/Position in Employment
1.
2.
3.
4.
5.
6.
7.
8.
PART C: APPLICANT’S EVIDENCE OF NEED
APPLICANT’S INFORMATION
Indicator Description
Why are you applying for a scholarship?
Have you received any financial support/bursaries in the past?
Please provide details:
Do you suffer from any physical impairment (disability)?
Do you have any disability or any chronic illness? If yes, kindly
describe and provide evidence:
Are you entitled to any form of inheritance from your parents/
guardians/any other source? Describe:
Who do you live with? Parent(s) n Guardian(s) n Other n Specify __________________________________________
PARENTS’/GUARDIANS’ INFORMATION
Indicator Father/Male Guardian Mother/Female
Guardian
Other
Age of your parents/guardians:
Does any of your parents have any form of disability?
Describe the disability:
Does any of your parents/guardians suffer from a
chronic disabling medical condition? Describe:
Are you living with both parents? If not, explain:
Are your parents/guardians employed? Give details of
job and salary per month: Attach Payslip
Do your parents/guardians own a business? Describe
and show the average monthly income: Bank
Statement
Do your parents/guardians own land/plot? State
number of acres, type of crops grown, number of
cows/sheep/goats/donkeys and income from such
assets:
Land size:
List livestock:
Do your parents/guardians have any other assets or sources of income, including casual labor? Indicate the approximate monthly income:
FAMILY INFORMATION
Indicator Description
Has your family been affected by civil conflict or natural disasters
such as displacement, flooding, drought, fire or famine? Describe:
What type of house do you live in? Describe such as grass
thatched, iron sheet, cemented etc:
Please describe any other cause of disadvantage or vulnerability?
Any siblings in i) Secondary School:
ii) University:
(SKETCH A DIRECTIONAL MAP TO THE HOME FROM THE NEAREST LANDMARK)
Part D: How did you first learn about the Wings to Fly scholarship program?
(Please mark only one)
n Equity Bank Branch (specify location)
n Equity Agent (specify location)
n School – teacher, principal or counselor (list name)
n Church, mosque, synagogue (specify name)
n Friends, parent, guardian or relative
n Internet (specify site)
n Radio, TV (specify)
n Newspaper, magazine (specify)
n Social networks such as Facebook, Twitter, Myspace (specify)
n Others (specify): ________________________________________________________________________
PART E: DECLARATIONS
APPLICANT’S DECLARATION
I, _________________________________________ declare that the information given above is true to the best of my knowledge and I am aware that giving false representation will mean that my application will not be considered and will lead to automatic disqualification.
I authorize Equity Group Foundation or its representatives to obtain such additional information concerning my educational program and financial records as needed to complete this scholarship application.
I also authorise Equity Group Foundation and its representatives to communicate and release information to others who are involved in making decisions relating to my educational plans including and not limited to my previous and future schools, referees named in this form and the Ministry of Education.
In the event I win the scholarship, I commit myself to working hard and posting excellent results throghout my secondary school course.
Signature:
Date
PARENT’S/GUARDIAN’S DECLARATION
I confirm that the above information is true to the best of my knowledge and I am aware that giving false representation will mean that the application will not be considered and will lead to automatic disqualification.
On behalf of my child, I authorise Equity Group Foundation or its representatives to obtain such additional information concerning this applicant’s education and financial records as needed to complete this scholarship application.
I also authorise Equity Group Foundation and its representatives to communicate and release information to others who are involved in making decisions relating to this applicant’s educational plans including and not limited to their previous and future schools, referees named in this form and the Ministry of Education.
Parent/Guardian Name ________________________________________________________________________
Signature:
Date
If you wish to provide additional information, please attach a separate piece of paper.
Part F: RECOMMENDATIONS
This part must be completed by the relevant authorities indicated. Any false infomation will Nlead to disqualification.
1. Primary School Head Teacher:
Please report on the above named applicant’s performance, conduct, special interests and talents. Also explain why he/she should be considered for the Wings to Fly Scholarship Program:
How long have you known the candidate /family? ___________________________________________________________________
My school has ______ pupils who sat for KCPE and in the most recent tests sat by the applicant before sitting for KCPE, this applicant’s position was no. ______ overall and attained ______ marks out of 500.
Report on any special interests or talents the child may have e.g. leadership, sports, arts, music etc:__________________________
Rate the candidate’s financial ability: n Very Rich n Rich n Middle Income n Poor n Very Poor
I have reviewed the information given in this form and believe it to be truthful. The above named student attended my school and based on my knowledge and/or inquiries, I affirm that he/she is needy/vulnerable. Please describe facts about his/her circumstances.
Name: Signature & Official Stamp: Date D D M M Y Y Y Y
Postal Address: P.O. Box: Town/City: Postal Code:
Telephobe/Mobile No.
2. Provincial Administration (Chief or Assistant Chief).
How long have you known the candidate/family? ____________________________________________________________________
Rate the candidate’s financial ability: n Very Rich n Rich n Middle Income n Poor n Very Poor
Yes No
Orphaned
Parents/Guardians are employed
Parents/Guardians
Any additional information, explain:
I have reviewed the information given in this form and believe it to be truthful. The above named student is a resident of my location/sub-location. Based on my knowledge and/or inquiries, I affirm that he/she is needy/vulnerable.
Name: Signature & Official Stamp: Date D M M Y Y Y Y
Postal Address: P.O. Box: Town/City: Postal Code:
Telephone/Mobile Number:
3. Religious Leader (bishop, pastor, priest, imam, etc.)
How long have you known the candidate/family? ____________________________________________________________________
Rate the candidate’s financial ability: n Very Rich n Rich n Middle Income n Poor n Very Needy
I have reviewed the information given in this form and believe it to be truthful. Based on my knowledge and/or inquiries I affirm that this student is needy/vulnerable based on the following facts about his/her circumstances.
________________________________________________________________________
Name: Signature & Official Stamp: Date D D M M Y Y Y Y
Postal Address: P.O. Box: Town/City: Postal Code:
Telephone/Mobile Number:
NB: If a family is found to have misrepresented their circumstances, the scholarship will be terminated and they will be required to refund fees paid.
Download this form here; The Equity Wings to Fly Application Form 2021.
