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SCHOLARSHIP APPLICATION FORM – COHORT SIX ACADEMIC YEAR 2020/2021

Makerere University in partnership with Mastercard Foundation is implementing a Scholars Program to enable

academically talented yet economically disadvantaged youth from Africa access quality undergraduate education.

Only students admitted to Makerere University main campus from the categories specified in the advertisement are

eligible to apply. A completed form should be submitted to Senate Building Level 4, Room 402 or sent through the

following email addresses info@mcfsp.mak.ac.ug or applications@mcfsp.mak.ac.ug Only short-listed candidates

will be contacted to appear for interview. Note that the application form is NOT FOR SALE and NO PAYMENTS

should be made by the applicant at any stage of the selection process. The deadline for submission is Friday 15th

May 2020 at 5.00 pm. Applicants are advised to read the application guidelines below before filling in the form.

ELIGIBILITY:

The applicant

a) Only youth in the categories below qualify to apply:

i. Refugees living in Uganda

ii. Internally displaced youth

iii. Students who completed the Uganda Advanced Certificate of Education (UACE) from schools located

in Northern Uganda.

iv. Students who completed the Uganda Advanced Certificate of Education (UACE) from schools located

in Eastern Uganda.

b) Must have completed A level studies in 2018 or 2019 and must not be a registered student of any other

University/Institution.

c) Must be admitted on private scheme to study at Makerere University main campus in the academic year

2020/2021. This means that in order to fit within the admission guidelines, all Scholarship applicants should

endeavor to apply for admission when Makerere University advertises for private sponsorship.

d) Must be from an economically disadvantaged background.

e) Should exhibit academic excellence in either Sciences or Arts with a minimum of 11 points for young

women and 13 Points for young men obtained in Uganda Advanced Certificate of Education (UACE) or its

equivalent obtained in 2018 and 2019.

f) Must demonstrate leadership potential and have a record of community service.

g) Should not be a holder of any other Scholarship.

COMPLETING THE APPLICATION FORM

A completed application should include the following:

a) Three Passport size photographs with the applicant’s name written at the back in block letters. (Paste one on

the form and two should be submitted in an envelope).

b) A copy of the applicant’s Birth Certificate.

c) A copy of Refugee Identity document where applicable

d) A copy of the academic documents including Primary Leaving Examination, Ordinary Level, and Advanced

Level Certificates.

e) Photocopies of Advanced Secondary Level bank slips.

f) Copies of death certificate(s) of biological parent (s) (if applicable).

Please paste recent

passport photograph. Do

attach and submit two

copies in an envelope

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g) Copies of result slip for term one and two of senior six

h) Hand drawn physical map of LC I /Village of residence with clear directions of how to get to the home of

residence (indicate approximate distances in kilometers from the main road).

i) Endorsement by the Head Teacher of the A-level School attended in Section G (signed and stamped).

j) Endorsement by the LC 1 of the District of Residence in Section H (signed and stamped)

k) Recommendation from the former sponsoring organization

OCCUPATION OF THE PARENTS OR GUARDIAN

This information must be as detailed as possible. Scanty information will be a disadvantage to your candidature. The

following categories are given as a guide but are not exhaustive.

1. If your father/mother/guardian is or was a businessperson, describe the business e.g. if he/she is a hawker, petty

trader, retail trader, wholesaler or manufacturer, describe the categories of the goods he/she trades in. In addition,

give the physical address of the business.

2. If your father /mother/guardian is an employee, state the position held and the organization/Ministry and the

corresponding salary scale.

3. If your father/mother/guardian is or was a farmer, state whether he/she is or was a subsistence farmer,

mixed/integrated/semi-commercial or commercial farmer and the type of farming i.e. whether it is keeping livestock

or growing crops or a combination of both. In addition, you should estimate the number of acres on which the

farming is done.

NOTE:

a) Whereas both male and female applicants are eligible, female applicants will be given priority.

b) Incomplete application forms will be automatically disqualified

c) All applicants or those who will submit the application form should ensure that they register in the book.

d) Applications slipped under the doors of any office will NOT be accepted.

e) This program exercises merit principles and zero tolerance to dishonesty. Any form of influence pedaling by

anybody will lead to automatic disqualification of the applicant.

f) Cases of impersonation, falsification of documents or giving false / incomplete information, whenever

discovered either at the time of receiving the award or afterwards will lead to automatic cancellation of the

award, refund of the money already spent on a beneficiary / prosecution in the courts of law of Uganda.

g) Filling in and submitting an application form does not guarantee one a scholarship.

h) Makerere University appeals to the public to be aware of fraudsters within or outside of the University, who

might want to take advantage of the scholarship application process by way of selling scholarship forms or

soliciting for money in the hope of securing an applicant a scholarship. Mastercard Foundation Scholarship

application form is free of charge; individuals caught in the act of conning the public will be prosecuted in

courts of law.

i) While the scholarship is a preserve of students admitted to Makerere University, the Scholarship

Coordination Office is not responsible for the requirements for admission into Makerere University. All

potential Scholarship applicants should meet the necessary requirements to be admitted into the University

on the private sponsorship scheme.

j) Only successful applicants will be notified at every stage of the scholarship application process, and the

decision of the Selection Committee will be final in the awarding of the scholarship.

k) Those applicants who will not have heard from us by 28th August, 2020 should consider their application

unsuccessful.

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To be filled by applicant (Incomplete applications will not be considered)

Section A. Personal Information of Applicant

A1 Surname (Block letters)

A2 First Name

A3 Middle name (if any)

A4 Date of Birth (dd/mm/yyyy)

(Attach a photocopy of a birth

certificate)

Age:

A5 Sex Male Female

A6 Place of Birth: District/State Country of Birth Nationality

A7

Current Contact Address

Village Sub-county

District of residence1 Country

A8 Name the nearest main road

from the district town to your

residence

Draw a sketch map of how one gets to your current residence on Page 11.

A9 Give a distinctive feature to

your residence

A10 Home Country and District if

different from current

residence

A11 Specify under which category

you are applying (circle the

appropriate)

i. Refugees living in Uganda

ii. Internally displaced youth

iii. Students who studied in secondary schools located in Northern Uganda.

iv. Students who studied in secondary schools located in Eastern Uganda.

NOTE: Refugee applicants should attach a copy of their refugee ID

1 Residence is the main place where the applicant has been living for the past two to five years

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B: Contact Information

B1 Applicant’s telephone number

B2 Permanent email address

B3 Guardian’s name and

telephone number

B4 Mother’s name and telephone

number

B5 Father’s name and telephone

number

School Contact Information

B6 Former School email address

B7 Former School telephone

number(s)

Other Contacts

B8

Other contact person likely to

know how to reach the

applicant in the future

B9 Relationship to applicant:

B10

Country of residence:

B11

Contact email address:

B12

Contact Phone(s)

Section C. Academic Information

Examination Year of

undertaking

this exam

State the

name of

the School

Overall

score or

grade point

State the location of the

School by region i.e

Western, Northern,

Central or Eastern region.

Type of

School (i.e

private,

USE, Gov’t)

C1 UACE/its equivalent

(Attach a photocopy of

result slip/certificate

and Identity Card) In

addition, provide copies

of academic reports for

term 1 and 2 of senior

six.

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Examination Year of

undertaking

this exam

State the

name of

the School

Overall

score or

grade point

State the location of the

School by region i.e

Western, Northern,

Central or Eastern region.

Type of

School (i.e

private,

USE, Gov’t)

C2 UCE/its equivalent

(Attach a photocopy of

a result slip/certificate)

C3 PLE (Attach a

photocopy of result

slip/certificate)

C4 Amount of fees paid at

each level PER TERM

(Attach a photocopy

of school fees bank

lip/School pay slip

Senior 6 TERM I TERM II TERM III

Senior 4 TERM I TERM II TERM III

C5 Indicate the subjects

offered at A level and

the grades obtained in

each

Subjects Letter Grade Grade Points

1.

2.

3.

4.

5. General Paper

Total

Section D: Family Background

Please indicate details of your parents in this section

Particular Father Mother

D1 Name

D2 Status (indicate whether alive or deceased) and

provide copies of death certificate/s if applicable

D3 Age of parents if alive

D4 District of residence

D5 Occupation/job tittle now or previously

D7 State total income per year

D8 Organization/place of work

D9 Highest level of education

D10 If deceased in NO. D1 above, state the name of the

guardian

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Particular Father Mother

D11 State the relationship with guardian

D12 Guardians occupation/source of income

D13 Who is the head of your house hold

D14 State the Head of Household income per year

D15. Occupational Status of head of household:

Employee - Full-Time Employment Retired - With Pension

Employee - Part-Time Employment Retired - Without Pension

Self-Employed - With Employees Not Employed

Self-Employed - Without Employees

Siblings and Dependants living in the household

D16 Number of siblings

D17 Number of

dependants

D18 Please provide detailed information about your brothers/sisters from your parents who are either out of

school or still in school

Name Age Current level

of education

Name of institution

where they are

currently

studying/working

occupation/source of income

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2

3

4

5

6

7

8

9

10

D19 Please provide detailed information about dependants in the household

Name age Current level of

education

Name of institution/ where

they are currently

studying/working

Occupation/sour

ce of income

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1

2

3

4

5

6

7

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D20 Total Number of people living in household including

the applicant:

D21 Does the household have electricity?

D22 State the type of roofing material

D23. Who paid for previous schooling? (check all that apply):

Employer Scholarship (Attach recommendation from the

sponsor)

Guardian(s) Self

Guardian(s) not related to

scholar

Sibling(s)

Other Relative(s) Sponsor(s)

Parent(s) Other

If ‘Other’, please state who paid fees …………………………………………………………………….……………..

E: Section E: Leadership Experience

E1 Describe previously held leadership position,

activities, or experiences: (i.e. positions where

the scholar has guided or led a group of people, a

project, or a cause) Please attach a certificate(s)

E2 State any Awards and Honors received: (i.e.,

secondary school citizenship award; president's

medal for outstanding leadership, etc.

E3. Participation in extracurricular activities:

Sports: State role Community services: State role

Religious Groups: State role Local organizations: State role

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E4. If Other, Explain …………………………………………………………………………………………………..…

E5. If you have been a member of a team, club, organization, or association, State your role:

………………………………………………………………………………………………………………………...…

E6. If you have previous work experience, please provide a short explanation of this experience

……………………………………………………………………………………………………………………………

……………………………………………………………………………………………………………………………

Section F: Community Service Experience

F1 Have you ever engaged in any voluntary

activity (Yes or NO)

F1 If the answer is yes. Describe your voluntary

activities and experiences

F3 Describe your aspirations for social change and

F4 How do you plan to achieve social change

through your career

F4. Which sectors do you plan to impact through your social change aspirations?

Agriculture Information Technology

Skilled Trades Public Service / Government

Small Business / Entrepreneurial Religious

Social & Humanitarian services Education

Health & Medical Other

If ‘Other’ please explain ……………………………………………………………………………….……………….

F5. Which sectors do you plan to impact through your career aspirations?

Agriculture Information Technology

Skilled Trades Public Service / Government

Small Business / Entrepreneurial Religious

Social & Humanitarian services Education

Health & Medical Other

School Clubs: State role Peer-to-peer groups: State role

Other

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If ‘Other’ please explain ……………………………………………………………………………………….……….

F6 Do you have any form of

disability?

Yes No

F7 If yes, what form of disability?

Attach your full photograph.

F8 How did you get to know about the scholarship opportunity?

Radio Newspaper Poster MCF Staff

Former School Friend/word of mouth Website

Others, specify

F9 What career do you plan to

pursue? (I.e. Doctor,

Humanitarian Relief Worker,

Entrepreneur, Teacher, etc.)

I declare that all the information provided here is true and accurate to the best of my knowledge,

and I have read and understood the note to applicants below.

Applicant: Parent/guardian:

Name:

_________________________________________

Name:

_________________________________________

Signature and Date:

______________________/_____/2020

Signature and Date: _______________/_____/2020

SECTION G: TO BE COMPLETEBY THE HEAD TEACHER OF YOUR FORMER ADVANCED LEVEL

SECONDARY SCHOOL

Please provide your assessment (to the best of your knowledge) about the applicant on:

a) Conduct /Behaviour

Excellent Very good Good Fair Poor

Please explain your assessment

……………………………………………………………………………………………………………………………

……………………………………………………………………………………………………………………………

b) Financial ability

Rich Middle-class Needy Very needy

Please explain your assessment

……………………………………………………………………………………………………………………………

……………………………………………………………………………………………………………………………

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Name and Signature of Head Teacher (with date and stamp)

Name: ____________________________________ Signature ________________________ Stamp

Mobile No. ___________________________________Date:_______________/_________________/__________

Comments on applicant’s previous sponsorship:

……………………………………………………………………………………………………………………………

……………………………………………………………………………………………………………………………

……………………………………………………………………………………………………………………………

H: TO BE COMPLETED BY LOCAL COUNCIL 1 OFFICIALS FROM THE DISTRICT OF RESIDENCE

VERIFICATION OF THE APPLICATION

LC I Chairperson

a) Surname_______________________________________________Other name(s) _________________________

b) Village (LCI) ____________Parish ______________Sub-County_________________ District _____________

c) Does the applicant reside in this village? Yes/No______________________ If yes, for how long______________

d) For how long have you known the applicant? _______________________________________________________

e) What is the applicants’ district of origin? __________________________________________________________

f) How many biological children are in her/his family? ___________________ How many are independent or

working? ________________

g) What does/ did the father do to earn a living?

______________________________________________________________________________________________

h) What does/did the mother do to earn a living? _______________________________________________________

i) Who was paying the applicants’ fees at secondary school level?

______________________________________________________________________________________________

j) Any other important information?

______________________________________________________________________________________________

k) RECOMMENDATION : Strongly Recommended Recommended Not Recommended

State the reason(s) for your recommendation__________________________________________________________

______________________________________________________________________________________________

______________________________________________________________________________________________

DECLARATION

I, the undersigned, hereby declare that I have carefully checked and verified the particulars stated above and certify

that they are true and accurate.

Name____________________________Signature_________________________ Stamp and Date

Telephone Number: ____________________________________________

‘Please note that submission of the application form does not guarantee getting the scholarship’

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Please draw a sketch map to your residence from the nearest main road and or trading center

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