MWALIMU JULIUS NYERERE MEMORIAL SCHOLARSHIP FUND SCHOLARSHIP APPLICATION FORM For Study in Tanzanian Universities 2015 (BACHELOR DEGREE PROGRAMMES) Mwalimu Julius Nyerere Memorial Scholarships recognize outstanding students particularly in Mathematics, Science and Technology, Economics, Accounting and Finance. Completed application form must be returned to: The Chairperson, Scholarship Awards Committee, Mwalimu Julius K. Nyerere Memorial Scholarship Fund, Bank of Tanzania, 2 Mirambo Street, 11884, DAR ES SALAAM. Photo Tel No. +255 22 2233041 Fax No. +255 22 2234088 For inquiries; E-mail: ksphelicean@bot.go.tz or mkkamuzora@bot.go.tz CLOSING DATE: 14th September, 2015 PLEASE COMPLETE THE FORM IN BLOCK LETTERS 1. Applicant’s Personal Particulars Full Name (Surname, First, Middle):-------------------------------------------------------Date of Birth (dd-mm-yyyy):-----------------------------Gender:---------------------------- Nationality--------------- Contact Details Postal Address: ----------------------------------------------------------------------------------------------------------------------------------------------- E-mail: ------------------------------------------------------------------------ Phone: ------------------------------------------------------------------------ 2. Details of Proposed Studies to be Undertaken Name of the Programme for the Scholarship: ---------------------------------------------------------------------------------------------------------Name and Address of University: -------------------------------------------------------- Duration of the Programme: -------------------------------------------------------- Programme Commencement: -------------------------------------------------------- 3. University/College Attendance Since Leaving School University/College Dates Attended From Grade Obtained To ----------------------------- --------------------------------- ------------------------------ ------------------------------ --------------------------------- ------------------------------ ------------------------------ --------------------------------- ------------------------------ ------------------------------ --------------------------------- ------------------------------ 4. Have you applied for any other scholarship for the proposed programme of study? If yes, please give details 2 SUPPORTING DOCUMENTATION Please attach the following: 1) A certified copy of the Result Slip for Advanced Certificate of Secondary Education Examination (ACSEE) 2) A certified copy of the Certificate of Secondary Education Examination (CSEE) 3) A certified copy of Birth Certificate. 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 RECOMMENDATION BY THE HEAD OF SCHOOL IN WHICH THE STUDENT IS CURRENTLY REGISTERED/LAST REGISTERED GENERAL CONDITIONS GOVERNING MWALIMU JULIUS NYERERE MEMORIAL SCHOLARSHIPS FOR UNDERGRADUATE 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 Scholarships. ii. The Scholarship funds will be disbursed in accordance with the university academic calendar and for the specified duration of a particular degree programme. iii. Scholarship recipients will be required to submit periodic academic progress reports to the Fund Administrator at the end of each semester. Subsequent disbursements for the next academic year will be subject to submission of satisfactory annual academic progress 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