Education Support Program Application

Last Name: *

First Name: *

Vulnerability: *

Date of Birth:

Gender: *

Male Female Other

Telephone No:

Applicant's Email: *

Religion: *

Emergency Contact Person:

Contact No:

Nationality: *

National ID/Passport No.:

Tribe:

Current District:

Current Address: *

Home District:

Permanent/Home Address (Address of Origin): *

SECTION B: FAMILY BACKGROUND

FATHER

Father Alive? *

Yes No

Father’s Full Name: *

Father's Tribe:

Occupation:

Employer/Organization:

Monthly Income (UGX):

Phone Contact:

Father's Email:

Father's Religion:

Father's Nationality: *

Father's Current District:

Father's Current Address:

GUARDIAN

Guardian (if applicable):

Relationship to Applicant:

Guardian's Occupation:

Guardian's Monthly Income (UGX):

Guardian's Contact No:

SECTION C: EDUCATIONAL BACKGROUND

PREVIOUS EDUCATION

Previous Secondary School Attended: *

Period Attended( Only in Entry and Exit Years):

Qualification Attained:

School Website/Contact Details:

Other Institutions Attended:

Course/Program:

Qualification Obtained:

Leadership positions involved (Previous/Current):

Voluntary/ Personal initiatives involved (Previous/Current):

CURRENT EDUCATION

Current University/Institution: *

Student ID:

Faculty/College:

Department: *

Course/Program of Study: *

Course Professional Achievement ( E.g. Doctor, Engineer, Teacher, Nurse, Medical Officer, Pilot, Lawyer etc.)

Course Duration: *

Current Year of Study:

Expected Year of Completion: *

SECTION D: FINANCIAL INFORMATION

SECTION D: FINANCIAL INFORMATION

Annual University Fees (Tuition, Accommodation, Living Expenses, Books, Total Annual Cost) (UGX): *

Current Source of Financial Support:

Current Sponsor (if any):

Amount/Percentage Covered (UGX):

Duration of Sponsorship:

SECTION E: SCHOLARSHIP REQUEST

Amount Requested (UGX): *

Study Payment Schedules: *

Term (3 annually) Semester (2 annually) Annual

Duration of Support Requested: *

Reason for Requesting Scholarship (Explain Financial Need): *

SECTION F: PERSONAL STATEMENT

Provide a short essay about yourself, academic and career goals, and how this scholarship will help.:

SECTION G: REFERENCES

Academic Referee (Name, Position, Institution, Contact):

Non-Academic Referee (Name, Relationship, Contact):

ATTACHEMENTS (ANY MISSING DOCUMNET MAY BE REQUESTED FOR AS AND WHEN REQUIRED)

1. Personal Identification Documents

Copy of National ID or Passport; Recent passport-size photograph

2. Academic Documents

Admission letter from the current university/institution; Most recent academic transcripts or results slip; Certificates from previous schools or institutions; Evidence of course registration (if applicable)

3. Financial Evidence

Proof of tuition fees structure from the university; Copies of receipts or invoices for paid or pending fees; Proof of household income (e.g., parent/guardian payslip, income statement, or affidavit of support); Any other relevant financial documents

5. Additional Supporting Documents

Budget breakdown (annual cost estimate); Any awards, honors, or certificates of leadership/community service; Medical report (if relevant to financial or special needs consideration)

ATTACHEMENTS

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SECTION H: DECLARATION *

I declare that all information provided in this application is true and complete to the best of my knowledge. I understand that false information or omission may lead to disqualification or withdrawal of any award.: I consent to my Information to be used as per the Nile Havens's Terms & Conditions

Signature of Applicant (legal name can apply): *

Signature Date: *

SECTION I: SUBMISSION DETAILS AND HELP

All applications must be submitted ONLINE. However, for any inquiry please send an email to: scholarships@nilehavens.com

Short privacy and Alert statement:

All personal information provided will be treated with strict confidentiality and used solely for scholarship and sponsorship evaluation purposes by THE NILE HAVENS.

All communication regarding the application will be via our official email above ONLY.

We strive to giving hope to all walks of life and we DO NOT ask for any payments regarding any application processes. Please report such act to admin@nilehavens.com for assistance.

THE NILE HAVENS EDUCATION SUPPORT PROGRAM APPLICATION FORM