Telephtinc.

- ; = ^ - t 30 005 Kisii Town Building

Fax: 058 - 307—
C O U N T Y G O V E R N M E N T O F KISII P.O.Box 4550 - 40200
E m a i l : infoe.kisu.go.ke Kisii Town
Website: \v\\-Av.kisii.go.ke
THIS FORM IS NOT FOR SALE
SERIAL NO:.
59270
2024 / 2025 EDUCATION WARD BURSARY FUNDS APPLICATION FORM
FOR UNIVERSITIES. COLLEGES. VTCS AND OTHER TERTIARY INSTITUTIONS
INSTRUCTIONS / GUIDELINES

1. This form is given FREE OF CHARGE by tfie County Government of Kisii

2. The information provided in the form is intended to help the County Bursary Committee to
understand the applicants academic and financial position, for the purpose of assessment for
bursary award.
3. The application form must be filled accurately and completely in CAPITAL LETTERS.
4. Canvassing will lead to automatic disqualification.
5. Must be a resident in the respective ward.

SUB COUNTY/
YEAR:
CONSTITUENCY:

WARD:

t*ART A: STUDENT PERSONAL DETAILS

1. NAME:

LAST: FIRST: MIDDLE:

01 m.n
2. SEX: MALE FEMALE:

3. DATE OF BIRTH:

4. NAME OF SCHOOL:

5. SUB COUNT\ / LOCATION: SUB-LOCATION:

CONSTITUENCY:
6. SCHOOL CONTACT NUMBER:

7. FORM / LE\'EL: YEAR: COURSE:

8. OUTSTANDING FEE BALANCE KSHS.

INING FORM 2, 3 A N D 4

SCHOOL ADMITTED: NATIONAL:

EXTRA COUNTY: COUNTY:

TOTAL FEES KSHS:

SCHOOL N / ^ " PER YEAR:

TT-. cr-XJr\^\^ CTTTT CX13TTrTTTRF T O R F A T T A C H E D

 FOR UNIVERSITIES. COLLEGES. VTCS AND OTHER TERTIARY INSTITUTIONS

YEAR: A D M NO:

A C C O U N T N A M E OF INSTITUTION:

ACCOUNT NO. COURSE:

O U T S T A N D I N G FEE B A L A N C E KSHS.

PART B: CURRENT SCHOOL BANK DETAILS^

N A M E OF SCHOOL:

BANK: BRANCH:

ACCOUNT NUMBER:

PARTC: FAMILY
OCCUPATION/
FATHER'S N A M E : -PPr
PROFESSION L
OCCUPATION/
MOTHER'S N A M E : .BJ^i-zh&Em K1^^^(5E'^' , PROFESSION
P A R E N T / G U A R D I A N / SPONSOR T E L E P H O N E N O :

I D N O / PASSPORT N O / H U D U M A N O :

ELECTORAL AREA (WARD):

(A) T O T A L O R P H A N : PARTIAL ORPHAN:

(ATTACH SUPPC)RTI\'G DOCUMESTS)

I F A N O R P H A N , W H O H A S B E E N P A Y I N G F DR Y O U R E D U C A T I O N (TICK) (FOR CONTINUING STUDENTS)

GUARDIAN: SPONSOR: W E L L WISHERS: O T H E R S (SPECIFY):

D O Y O U H A V E A N Y FORM OF D1SABILIT\'?
YES: NO:

I F YES, SPECIFY T H E F O R M O F D I S A B I L I T Y :

PARENT / GUARDIAN DECLARATION

I D E C L A R E T H A T I H A V E R E A D A N D U N D E R S T O O D T H E I N F O R M A T I O N A N D I HEREBY
C O N F I R M T H A T T H E I N F O R M A T I O N G I V E N H E R E I N IS T R U E T O T H E BEST O F M Y K N O W L E D G E
A N D BELIEF.
PARENT / G U A R D I A N N A M E : | j^LlZ/^B^rH h\^RBK I
I D N O / PASSPORT N O / H U D U M A N O :

CONTACT: SIGNAIURE: DATE:

WITNESS:
 iiiMitiwi^'t'iiiiiiLjirtii''-'

i<f:i*»iui.i< oi Kr'N\
1

aSRTIFICATE BIRTH

• !l lIlC. G ^ J ^ ' " ^ ,.„..,.., DiMnc.i.nhc NYANZA p,,i,,,

i/l
Where. '
Kciiycnya
L.0551800529 Miriam Obutu
Sub-Location

2"" September, 2007 Isaac Otara Omare

I Female

Niiriio itiid Maiden

Name i)f Mntiiic) Elizabeth Nyambeki Otara

Sgd. Mother

G.N. Daudi 11'"January, 2018

G.N. Daudi Distrki'.Vssistani

Gucha Disirici- hcf\

G C A / C A No.3631 of 11 -01 -2018

Auth. NO.0529/GCA of 12-01-2018

28th
C,in oil i'-.jv r : Seal d !*K' ' • ,r nioii on (ho MW^' im.
Binh-. and Dec ., I •!•'>) vv!iii.i! provides that ci
. s t h ilie Scifi of ihc Director
or sued without anv or other
lU"v
 NYABISASE SCHOOL
P.OBOX 2989-40200,KISI!
0725886259
nyabisasehigh(S>gmail.coiTS

A C A D E M I C REPORT F O R M - FQRM 3 - END Y E A R - 2 0 2 4 - ( 2 0 2 4 TERM 3 )

NAME: Miriam Obutu Otara Subject Performance - Student v s C l a s s

100 _
ADMNO: 9241 Miriann Fornn 3
FORM : 3 C
UPl: GCRU8R
KCPE: 196
VAP: 7.15
ENG KIS MAT BIO PHY CHE HIS EST

Moan Total Marks Total Points S t r e a m Position Overall Position

A I 81% 34.8 565/700 244 J 83/84 3G i 23/79 41 t 130/816 407 i

SUBJECT CAT1 END YEAR-2024 RANK COMMENT TEACHER

MARKS DEV. GR.

tnglish 37% 76% +39 } A 35/78 Excellent worl< Akeya Akeya

Kiswahili 78% 83% +5 i A 30/78 Vizuri S a n a Okioga

Mathematics 34% 70% +36 } A 33/78 Excellent woric Raphael

Biology 54% 95% +41 i A 23/79 Excellent work Nehemiah A n y o n a

Physics 10% 59% +49 } B 14/23 Good, c a n d o better Aoko

Chemistry 28% 83% + 55 } A 12/78 Excellent work MARGARET

History a n d 57% 71% +14 i A- 56/73 Very g o o d work i '^'-^ Osiemo

Government

Business Studios 33% 87% + 54 t A 5/14 Excellent work Catherine

Remarks Signature
Miriam C b u t u Otara's Performance over Time .8.,

100 Neht-miah Anyone - C!at^- T e a c h e r

Excellent work, keep it up to maintain thesi
encouraging results.

Parent's Signature:

<^:f <^^:^ <.^1^ .<on^

V' V'

SCHOOL DATES S c a n to a c c e s s your interactive student profile o n

Zeraki Analytics. Your u s e r n a m e : 9241(5)nyabisase
Closing Date: 17/10/2024

Opening Date: 08/01/2025

rr.
 1

^^ABISASE MIXED SECONDARV SCHOOL

P.O BOX 2 9 6 9 - 4 0 2 0 0 , KISII
MOTTO: KNOWLEDQE IS POWEE
EMAIL; secondarynyabisase@ginaiLcom

FEES S T R U C T U R E F O R T H E Y E A R 2 0 2 5

TERM 1 TERM 2 TERM 3 TOTAL

FORM 2025 M& 1 TOTAL 2025 2025 2025
2 22,100 2000 24,100 10,435 6,000 40,535
3 22,100 2000 24,100 10,435 6,000 40,535
4 27,000 2000 27,000 10,535 3,000 40,535

BREAKDOWN OF FEES PER VOTEHEAD

VOTEHEAD PARENT
TEACHING LEARNING MATERIALS ANDEXAMS 0
BOARDING EQUIPMENT AND STORES 29,000.00
REPAIRS , MAINTENANCE AND IMPROVEMENT 2,000.00
PERSONAL EMOLUMENT 2,000.00
ACTIVITY • 535.00
E.W.C 1,000.00
L.TT 2,000.00
ADMINISTRATION COST 2,000.00
MEDICAL AND INSURANCE 0.00
PA 2000.00
TOTAL 40,535

1. The school accepts o r i g i n a l b a n k pay i n slips only.

2. Fees to be p a i d t h r o u g h the following b a n k a c c o u n t s or MPESA p a y m e n t .

B A N K PAYMENT p
> A / c No. 0 1 1 3 9 6 7 1 5 0 9 7 0 0 - COPERATIVE B A N K KISII B R A N C H

> A / c NO. 6 4 3 3 - 0 0 4 - 1 6 5 4 3 - WAKENYA P A M O J A SACCO SOCIETY L T D

:• V • (OGEMBO BRANCH)
MPESA PAYMENT
1. M-PESA PAY BILL NO: 4078413 ACCOUNT NAME-STUDENTS ADM.NO
2. EQUITY PAY BILL: 247247 ACCOUNT NAME:284219#ADM NO.
3. KCB PAY BILL: 522533 ACCOUNT NAME: 7953998# ADM NO
B U S I N E S S NAME rNYABISASE SECONDARY S C H O O L

• NO CASH PAYMENT AND PERSONAL CHEQUES WILL BE ACCEPTED

• NOTE: DUE TO FRAUD, THE SCHOOL DISCOURAGES PAYMENT THROUGH
BANK AGENTS
 KENYA MEDICAL TRAINING C O L L E G E

FEES AND OTHER CHARGES 2023/2024 ACADEMIC YEAR

IN-SERVICE - YEAR 1

S/NO ITEM A MOUNT (KSHS.)

SEMESTER 1 SEMESTER 2 TOTAL P.A
1. Registration Fee 2,000.00 - 2,000.00
2. Processing Fee 1,500.00 - 1,500.00
3. Activity Fee 1,000.00 1,000.00 2,000.00
4. Examination Fee 5,000.00 5,000.00 10,000.00
5. Librarv and ICT services 2,000.00 2,000.00 4,000.00
6. Tuition Fee 15,000.00 15,000.00 30,000.00
7. Research and Development Fee 5,000.00 5,000.00 10,000.00
8. Transport Fee 6,000.00 6,000.00 12,000.00
9. Maintenance Fee 5,000.00 5,000.00 10,000.00
10. Student Identity Card 700.00 - 700.00
TOTAL KSHS. 43^00.00 39,000.00 82^.00

Charges for meals and accommodation shall be payable directly at the respective
college at applicable rates. The respective college bank account details shall be
I provided upon admission for this purpose.

Notes:
b. The fee structure is currently being discassed by the Ministry of Health and any
changes that may be approved will be communicated to you.

c. Should a student be discontinued on Academic grounds and/or any other reasons, he/she
will be expected to pay full fees accordingly on resumption of training.

d. Upon dismissal or abscondment fees is not refundable.

e. Students are advised to make own arrangements to cover personal expenses incurred
during Practical Attachment, Research etc, details of which are availablefromrespective
faculties.

e. Students are encouraged to pay applicable year's fees in fiill at the beginning of the
academic year but may pay in installments (1st Installment Kshs.43,200.00 payable on/or
before registration and Kshs.3 9,000.00 on/or before commencement of 2"** semester.

f. All students to be vaccinated against Hepatitis B and Typhoid before repor

college and produce a valid vaccination certificate from a recognized healthy
admission.
All students to have an NHIF Cover or present a Copy of the Parent's NHIF < tmission
to the college.
 KMTC/QP-08/1SS

KENYA MEDICAL TRAINING COLLEGE - Kangundo Campus

QUALITY MANAGEMENT SYSTEMS

INDIVIDUAL SCORE SHEET
— FACULTY OF CLINICAL SCIENCES
DEPARTMENT OF ORTHOPAEDIC AND TRAUMA MEDICINE

PROGRAM: UPGRADING DIPLOMA IN ORTHOPAEDIC AND TRAUMA MEDICINE

CLASS: MARCH 2024 ACADEMIC YEAR: 2023/2024

YEAR OF STUDY: YEAR 1 SEMESTER 1

STUDENT NAME: Jason Mogire Otara STUDENT NUMBER: D/UPOTM/24070/668

S.NO SUBJECT SCORE GRADE

1. HUMAN ANATOMY 72 B
2. MEDICAL PHYSIOLOGY 70 B
3. COMMUNICATION SKILLS 79 A
4. HUMAN PSYCHOLOGY 67 B
5. PATHOLOGY 62 C
6. COMMUNITY HEALTH 87 A
TOTAL MARKS (OUT OF 600) 437
AVERAGE (%) 73
REMARKS

STUDENT NAME Jasqn .Mqgjre.Ota DATE 03/09/2024

HEAD OF DEPARTMENT EMILY THIGU SIGN DATE 03/

ACCQU|^{T NUMBERS FOR F E E PAYMENT
1) 01003086514000 AT NATIONAL BANK, HOSPITAL BRANCH, NAIROBI.
2) 1158030274 AT KENYA C O M M E R C U L BANK, MOI AVENUE BRANCH, NAIROBI

Depoffits can be made at ai^ branch countrywide. Direct cash payments to the college will not
be accejvtcd.

15th June 2023

 3 ^ RON GO '
^=5^=5? U N I V E R S I T Y

- Si:n001 AM'saUNCU,AGiyCULlXIIUi AND ENVIRONMEWAL STUDIES

I N l >i l u .K \ >i !,\1 I I I . .s I K u c r i UKI-: i o i < 202.5/2024 T O 2 0 2 6 / 2 0 2 7 A C A D E M I C Y E A R S ~
111 s i K i K iDKi ioKsrui)i:Nisi'i,Ac:i-;i) B Y K U C X : P S A N D U N D E R N E W F U N D I N G M O D E L j

1111 O R o i - SC;II:N(;I; I N I ASI I I O N DF:SIGN A N D T E X T I L E TECHNOLOGY

, SN DESCRIPTION FIRST YEAR SECOND YEAR THIRD YEAR FOURTH YEAR

SBM. I SBM. 2 SEM. I SEM. 2 SEM. I SEM. 2 SEM. I SEM. 2
I 1 IIKUHl I'c-r 79,0.S() 79,050 76,925 76.925 77,925 77,925 84,425 84.425
J I,{HX>
.< Rl'SA MoinlHi>l>tp l-Vo 500
Rl'S.\i IVo 300 300 300 300 300 300 300 300
5 K. 1 S<T\C I'cO 3.000 3,000 3.000 3.000 3,000 3,000 3,000 3,000
Inviii^crul Atrjcliciucnr 5,500 5,500
- Ficici CoiIlM* 5,500 5,500
1,500
CUE Qujlitx .-\sMirancc Fee 1,000 1,000 1,000 1,000
10 Ljboraiorv / Practical Fco 4,000 4,000 3,000 3,000 2,000 2,000 1,000 1,000
11 L i b r i i i Fee 500 500 500 500 500 500 500 500
12 .Adinini&rrjnve Fee 13,800 12,500 13,050 11,500 13,050 11,500 13.050 11.500
SEMESTER TOTAL 104,650 99350 103,275 100,725 103,275 100,725 103,275 100.725
YEAR'S TOTAL 204,000 204,000 204,000 204,000

IMPORTANT NOTES ' , ^.

1. This fees scnicTure may be revised by the University Council when necessary.
2. Apart from paying fees, students shall provide for their own accommodation, food and other personal expenses.
3. Students from outside the East African Conimunity ( E A C ) shall pay 20% more of tuition fees.
4. Accommodation fees if in University residence will be charged at the rate of Ksh. 8,000 per academic year and a deposit of Ksh.
1,000 refundable at the end of the academic year.
5. Fees are payable only through Bankers Cheque in favour of Rongo University or through e-citizen as indicated in the procedure
below.
6. T h e indicated fees iiave been subsidised by the University at 15% of the Differentiated Unit Cost ( D U G ) .
7. Students are encouraged to apply to Higher Education Financing for scholarship, loans and bursaryfwvjy.hcf c
3. Graduation tec amounting to KSh.5,500 will be charged in the Fourth Year of study at thytitc of K.Sh.2^50 for each seme^p^T.

FEE PAYMENT PROCEDURE

[. I.ovjin to your studrnr .iccoiinf from the student portal
'2. Go ro r-paymi-nr
'.i. (,Uo<>tr the charge item e.g. for fee payment, choose fees and the correct study level e.g. Fees-Degree
4. Inp.ir rhi- .irnount ri; be p.nH then click on proceed
'i. Cli'jov rlir paynirnr metluui from the payment page e.g. MPESA ] ,\ I: .
h. Cfioow rhr ifciwid option ri> finisli the payment process ^. f,^
7. Aft'-r you Iiavr r-riivrd ilir Mpe'..i coiifirm.ition mess.ige, click on complete. -S t'u:.j'.,

16 SEP 202^1
u
 R I l ' U B l i r Ol K E N Y A

CERTIFICATE OF BIRTH
GUCHA
Birth in I I K District in thi NV'ANZA Province

Entry ' When-

L.0551800530 Kenyenya
Esther Kwamboka
Sub-Location
NauK- antl
15* June, 2010 Isaac Otara Omare
Hi! ill Female Surname ot Fatliei

Nanie and Maiden

Name ut Mother Elizabeth Nyambeki Otara

j4 Name and D e s e r i p t » §
••• . of Informant Sgd. Mother

Name (if R e L : i > l r i lii- Date of

OtViccr G.N. Daudi Registration 11* January, 2018

r G.N. Daudi Disirii I As.sistant

R Gucba Distriii. hertfterTTiTi]^

Ironi an cniiA return ni the Reeisier of B i t i i i N in llie District.

G C A / C A No.3633 of 11-01-2018
Auth. NO.0530/GCA of 12-01-2018

28th
Ciiven inuler ihv; Sea! • W liu' P i v il ReL'i (Ml HT c f e ^ ' 2018.

This e e n i l K a k issued in pursuance o i the Births and Deaths Registration Art (Cap. 149) which provides that a
certified copy of any entry in any reeisiei or return pinporling to be sealed or stamped w ith the Seal of (he Director
ol CiN il RcLiistration shall be received us evidence ol tlie dates and tacts therein contained without an\r other
p r o o l o f siicli entry.
 NYABISASE S C H O O L
P.OBOX 2989-40200,KISII
0725886259
nyabisosehigh(S}gmail.com

A C A D E M J C REPORT FORM - FORM 1 - t N D Y E A R - 2 0 2 4 - ( 2 0 2 4 TERM 3 ) :

Subject Perf ormance - Student v s C l a s s

I NAME: ESTHER KWAMBOKA OTARA
100

ADMNO: 11414 - * - ESTHER l^F^ffth^

FORM :1V
KCPE: 247
I VAP: 4.64
i ENG KIS MAT BIO PHY CHE HIS CRE BST

Mean Total Marks Total Points S t r e a m Position Overall Position

37 J- 259 i 35 1 297 1
A - I 77% 537/700 74/84 33/59 0-> 262/927

END YEAR-2024 RANK COMMENT TEACHER

SUBJECT CAT1
MARKS DEV. GR.

English 68% 79% +43 1 A 18/59 Excellent work Sheba

Kiswahili 32% 53% + 21 + C + 50/59 Wastani Lennox

Mathematics 22% 44% + 20 f C- 33/59 Below a v e r a g e , c a n do better manoti

Biology 26% 90% +68 J A 14/58 Excellent work MORANGA Momanyi J air u s

Physics 31% 41% + 11 J C- 32/59 Below a v e r a g e , c o n d o better Omenyo

Chemistry 25% 73% + 41 i A- 28/59 Very good work NYAKUNDI

History a n d 37% 73% + 73 i B+ 33/59 G o o d work but a i m higher Daisy

Government

C.R.E. 33% 94% + 20 • A 14/59 Excellent work Daisy

Business Studies 50% 84% + 34 .t A 51/59 Excellent work Moywaywa

ESTHER KWAMBOKA OTARA's P e rfo rman c e over Time Sinnature

100 : —- Class Teacher

75 - - Excellent work, keep it up so a s to improve
50 * further.
25 Parent's Signature:

««-«^ P.O. B O ^ g^^j^, „

DATE'-
S c a n to a c c e s s your interactive student profile on
Zeraki Analytics. Your u s e r n a m e : 11414(5>nyabisase