MWALIMU JULIUS K. NYERERE MEMORIAL SCHOLARSHIP FUND SCHOLARSHIP APPLICATION FORM For Study in Tanzanian Universities 2013 (MASTERS DEGREE PROGRAMMES) Mwalimu Julius K. Nyerere Memorial Scholarships recognize outstanding students particularly in Mathematics, Science and Technology, Economics, Accounting and Finance. Completed application form must be returned to: The Fund Administrator, Mwalimu Nyerere Memorial Scholarship Fund, Bank of Tanzania, 10 Mirambo Street, P.O. Box 2939, DAR ES SALAAM Tel enquiries: +255 22 2235149 Photo E-mail: ksphelicean@bot.go.tz or mkkamuzora@bot.go.tz CLOSING DATE: 17th August, 2013 PLEASE COMPLETE THE FORM IN BLOCK LETTERS 1. Applicant’s Personal Particulars Full Name (Surname, First, Middle):-------------------------------------------------------Date of Birth (dd-mm-yyyy):------------------------------ Nationality--------------- Gender:-------------------2. Contact Details Postal Address: ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- E-mail: --------------------------------- Phone:----------------------------- 3. Parent / Guardian Details Full Name (Surname, First, Middle)--------------------------------------------------------Date of Birth (dd-mm-yyyy):------------------------------ Nationality--------------- Occupation: ------------------------------------------------------------- Postal Address: ------------------------------------------------------------------------------------------------------------------------------- Residential Address: ------------------------------------------------------------------------------------------------------------------------------- E-mail: ------------------------------- Phone:--------------------- 4. Details of Proposed Studies to be Undertaken Name of the course for the Scholarship: ---------------------------------------------------------------------------------------------------------Name and Address of University: ------------------------------------------------------ Duration of the Course: -------------------------------------------------------- Course Commencement: -------------------------------------------------------- 5. University/College Attendance Since Leaving School University/College Dates Attended From ----------------------------- Grade Obtained To --------------------------------- ------------------------------ ------------------------------ --------------------------------- ------------------------------ ------------------------------ ----------------------------------- ------------------------------ ------------------------------ ----------------------------------- ------------------------------ 6. Have you applied for any other scholarship for the proposed course of study? If yes, please give details ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------2 SUPPORTING DOCUMENTATION Please attach the following: 1) A certified copy of a Statement of Results/Bachelor degree certificate. 2) Certified copies of the Advanced Certificate of Secondary Education Examination (ACSEE) and the Certificate of Secondary Education Examination (CSEE). 3) A certified copy of Birth Certificate. 4) A brief statement of intent explaining why a particular programme has been chosen and how it will further your educational and career goals. The statement should be no more than two pages in length, double spaced. Your name should appear on each page. 5) A detailed Curriculum Vitae. 6) Completed Recommendation Forms with official stamp from two Department’s member of staff of the University in which the student was last registered for undergraduate degree. The recommendation should be in a sealed envelope. I certify that the information in this application is correct to the best of my knowledge, and in the event I am awarded a scholarship, all funds will be used to further my education in the specified field. Signature--------------------------------- Date-------------------------- 3 GENERAL CONDITIONS GOVERNING MWALIMU JULIUS K. NYERERE MEMORIAL SCHOLARSHIPS FOR POSTGRADUATE STUDIES IN ACCREDITED UNIVERSITIES OF THE UNITED REPUBLIC OF TANZANIA i. The Fund will offer Scholarship to applicants who have not been granted any other Scholarship. ii. The Scholarship funds will be disbursed in accordance with the university academic calendar and for the specified duration of a particular degree course. iii. Scholarship recipients will be required to submit periodic academic progress reports to the Fund Administrator at the end of each semester. Subsequent disbursements will be subject to submission of satisfactory reports. iv. A student sponsored by the Fund shall not be allowed to change her/his course of study without prior permission of the Sponsor. v. The Scholarship can be terminated in the event of consistent unsatisfactory performance or poor performance leading to repeating an academic year or discontinuation of studies. 4