Form NM-A102

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THE NELSON MANDELA AFRICAN INSTITUTE OF SCIENCE AND TECHNOLOGY, ARUSHA

APPLICATION FOR SCHOLARSHIP

THIS FORM IS APPLICABLE ONLY TO THOSE WHO ALREADY FILLED FORM NM-A101

Please tick √ type or use block letters

Intended Degree Programme Master’s PhD

Programme to which admission has been sought.

If you have applied for more than one programme indicate preference (e.g., 1,2,3 … etc.)

Life Sciences and Bio-engineering [LSBE]

Mathematics and Computational Science and Engineering [MCSE]

Information and Communication Science and Engineering [ICSE]

Hydrology and Water Resources Engineering [HWRE]

Environmental Science and Engineering [EnSE]

Materials Science and Engineering [MaSE]

Sustainable Energy Science and Engineering [SESE]

Personal Details

Title Mr. Mrs. Ms. Miss Other (________________)

Surname

First Name

Middle Names

Birth Date: dd-mm-yyyy - -

Gender and Marital Status Male Female Single Married Other

Nationality

FOR OFFICIAL USE ONLY

Ref. No.

Code

11:: IInnffoorrmmaattiioonn oonn PPrrooggrraammmmee ooff SSttuuddyy

22:: PPeerrssoonnaall DDaattaa

Affix a colour photograph (35mm x 45mm)

Form NM-A102

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Contact Address

Street

Code/P.O. Box

Town/City

Country

Phone No - -

- -

Email Address

Give details of your most current and valid Identification (attach copy)

Passport No:

Employment ID No:

Other (Specify)

Are you employed? Yes No

If Yes, (i) State name and address

of the employer

Employment Position

(ii) State your current business and/or occupation

If No, state your current business and/or occupation

What is your Career Plan after Graduation

Provide Names of Sponsor(s) of your earlier studies: (i) Bachelor’s degree studies: …………………………………………………………………..…………………………

(ii) Master’s degree studies………………………………………..………………………………………………………… PhD applicants must fill both (i) and (ii)

3: Evidence of Identity

44:: Career Details

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Form NM-A102

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I wish to seek NM-AIST’s assistance to secure Full Scholarship

Partial Scholarship

If you are applying for Full Scholarship, state why?

If you are applying for Partial Scholarship, state the proportion:

I ………………………………………………………………………………………. certify that the information given in this application form and the supporting documents are correct and complete. I understand that submission of (i) incorrect information may be a sufficient cause for refusal of scholarship or termination of registration; (ii) incomplete information may result into total disregard of the application.

……………………………………………… ……………………………….. Signature Date

55:: Application for Scholarship

6: Declaration

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