FORM A: APPLICATION FORM(2024)

Branch _____________________________

WINGS TO FLY SECONDARY SCHOOL SCHOLARSHIP PROGRAM

DATA PROTECTION OVERVIEW

In accordance with the Data Protection Act, 2019, and Regulations, as amended and reviewed from time to time (Data Protection Laws), Equity Group Foundation (“EGF”) is a not-for-profit organization registered as a limited by Guarantee entity under the laws
of Kenya. EGF is collecting consent from the parent(s) or guardians, on behalf of the applicants as minors to ensure compliance.

EGF is committed to protecting the privacy and security of personal information. This Privacy Notice explains how we collect, use, and disclose personal information in connection with the Wings to Fly Secondary School Scholarship Program.

Click here to download the Wings to Fly Application Form 2024

Information we collect

EGF will collect the following types of personal information through application forms provided at the Equity Bank (Kenya) Limited
Branches or through events organized by EGF:
• Contact Information: Names, addresses, phone numbers and e-mail addresses.
• Demographic Information: Date of Birth, gender, health status and other relevant demographic details.
• Academic Information: Educational background, grades and other academic records.
• Program Participation Information: Data related to participation in the Wings to Fly Program, including attendance, performance, sibling information and referrals.

How we use your information

• EGF uses your personal data for the following purposes:
• Program Administration: To manage and administer the Wings to Fly Program, including fair scholarship distribution and academic support.
• Communication: To communicate with participants, parents or guardians regarding program updates, events, and relevant information.
• Research and Reporting: To conduct research and generate reports to improve the effectiveness of the program.
• Compliance: To comply with Legal and Regulatory requirements.
• Sensitive Personal Data
• EGF collects health information, property details, family details including names of the person’s children, parent(s), guardians, spouse or spouses and gender. Under the Data Protection Laws, these data categories are termed as sensitive personal data.
• EGF uses your sensitive personal data for the following purposes:
• Program Administration: Your health information, gender and family details are collected and used to ensure fair scholarship distribution.
• Home Visit: To conduct follow up visits, if successful after the interviews. The visits are structured to be impromptu, without the knowledge of the applicants to avoid instances of fraudulent applications.

Information Sharing

We may obtain and or share personal information:

• EGF may obtain additional information concerning the applicant’s education and financial records, as needed to complete this scholarship application.
• EGF may also communicate and release information to others who are involved in making decisions relating to the applicant’s educational plans, including, and not limited to their previous and future schools, Referees named in this form and the Ministry of Education.
• EGF may also share your personal information with the donors, certified counsellors, psychosocial and medical service providers, and mentors.

Data Security

EGF implements adequate technical and organizational measures to protect personal information from accidental or unlawfuldestruction, loss, alteration, unauthorized disclosure of, or access to, personal data.

Data Transfers & Cross-Border Transfers

Once the forms are received, the data is transferred to the EGF Data Management Information System (DMIS). The physical forms are then archived based on Bank Policies by the branches that received the personal data.

In the course of our operations, personal data may be transferred to entities located outside Kenya. Such transfers could be necessary to provide oversight to our donors, who are located outside the country. EGF takes measures to ensure that your data remains adequately protected and that these transfers comply with the Data Protection Act, 2019.

Applicants Data Subject Rights

Applicants can exercise their rights to access, rectify, erase, restrict processing, data portability, object and in relation to automated decision making and profiling by sending a request to: [email protected]. We may however continue to process where we
have a legal basis of processing.

CONSENT FROM THE PARENT(S) or GUARDIAN

I, ____________________________________________________, hereby provide my consent to EGF for processing of my sensitive personal data for the purposes described above.

EQUITY BANK WINGS TO FLY SCHOLARSHIP INSTRUCTIONS/GUIDELINES

• This form is given FREE OF CHARGE by the Equity Group Foundation
• The information provided in this form is intended to help the Equity Group Foundation Community Scholarship Selection Board understand the applicant’s academic and financial position for the purpose of assessment for scholarship/award
• This application form must be filled accurately and completely in CAPITAL LETTERS
• On being called for an interview, the applicant must bring the originals of all documents attached
• All incomplete or inaccurately filled forms will be automatically rejected
• Copies of ALL DOCUMENTS required must be provided by the applicant. Any applications without relevant documents will be rejected
• Canvassing will lead to automatic disqualification
• The completion and submission of this form is not a guarantee for sponsorship
• Any false statements, omissions or forged documents will lead to automatic disqualification
• Equity Group Foundation reserves the right to make the final determination of scholarship beneficiaries
• Only 2023 KCPE candidates will be considered
• The application can also be submitted through the Wings to Fly online platform https://egfdmis.equitybank.co.ke/register_w2f
• Every part of this form must be filled. Failure to do so makes this application form incomplete and therefore renders the applicant illegible for the scholarship

PART A: APPLICANT’S PERSONAL DETAILS
PERSONAL DATA

Full Name of Applicant:
First Name: _________________________ Middle Name:__________________ Surname/Family Name: _____________________

Date of Birth: D D M M Y Y Y Y

*(Attach copy of birth certificate)
Telephone/Mobile No. Alternative Mobile No.

Physical Address: County :_________________________________ Sub-County: __________________________________________
Ward: __________________________________ Location: ______________________ Sub-Location: ________________________

ACADEMIC INFORMATION
Name of Primary School Attended: ______________________________________________________________________________

Postal Address: P.O. Box: Town/City: Postal Code:

Telelephone/Mobile No. Alternative Mobile No.
Physical Address: County: ____________________________________ Sub-County: ______________________________________
Ward: _____________________________ Location _____________________________ Sub-Location: _______________________
KCPE Index No. KCPE Marks:
(Attach copy of results slip or one provided by the Headteacher of your former school with his/her certification)

Year sat for KCPE: ________________ Have you attempted KCPE in previous years? Yes n No n

If yes, how many times and why? ______________________ Please indicate the KCPE

scores attained for previous years: _______
Have you repeated any class? (1-8) while in primary school Yes n No n If yes which ones ____________________________

PART B: APPLICANT’S FAMILY INFORMATION
PARENTS’ INFORMATION
Father’s Full Name:

First Name:__________________________ Middle Name:_________________________ Surname: __________________________
ID No. Living: Deceased: [If deceased, please attach copy of death/burial certificate]
Physical Address: County: ____________________________________ Sub-County:_______________________________________
Ward: _____________________________ Location: _________________________ Sub-Location: ___________________________
Postal Address: P.O. Box: Town/City: Postal Code:
Telephone/Mobile No.
Source of Income: ____________________________________________________________________________________________

Mother’s Full Name :
First Name: ________________________ Middle Name: ________________________ Surname: ____________________________
ID No. Living: Deceased: [If deceased, please attach copy of death/burial certificate]
Physical Address: County: __________________________________________ Sub-County: _________________________________
Ward: _____________________________ Location: _________________________ Sub-Location: ___________________________
Postal Address: P.O. Box: Town/City: Postal Code:
Telephone/Mobile Number:
Source of Income: ____________________________________________________________________________________________

Are your parents living together? Yes n No n

GUARDIAN INFORMATION (If not living with the parents)

First Name: _____________________________ Middle Name:_____________________ Surname :__________________________
ID No. Relationship with student/applicant:_______________________________________
Physical Address: County: __________________________________________ Sub-County: _________________________________
Ward: _____________________________ Location: _________________________ Sub-Location: ___________________________
Postal Address: P.O. Box: Town/City: Postal Code:
Telephone/Mobile Number:
Source of Income: ____________________________________________________________________________________________

PART C: APPLICANT’S EVIDENCE OF NEED

APPLICANT’S INFORMATION

Indicator Description
Why are you applying for a scholarship?
Have you received any financial support/bursaries in the past?
Please provide details:
Do you suffer from any physical impairment (disability)?
Do you have any disability or any chronic illness? If yes, kindly
describe and provide evidence:
Are you entitled to any form of inheritance from your parents/
guardians/any other source? Describe:
Who do you live with? Parent(s) n Guardian(s) n Other n Specify __________________________________________

PARENTS’/GUARDIANS’ INFORMATION
Indicator Father/Male Guardian Mother/Female
Guardian
Other
Age of your parents/guardians:
Does any of your parents have any form of disability?
Describe the disability:
Does any of your parents/guardians suffer from a
chronic disabling medical condition? Describe:
Are you living with both parents? If not, explain:
Are your parents/guardians employed? Give details of
job and salary per month: Attach Payslip
Do your parents/guardians own a business? Describe
and show the average monthly income: Bank
Statement
Do your parents/guardians own land/plot? State
number of acres, type of crops grown, number of
cows/sheep/goats/donkeys and income from such
assets:
Land size:
List livestock:
Do your parents/guardians have any other assets or
sources of income, including casual labor? Indicate
the approximate monthly income:
FAMILY INFORMATION
Indicator Description
Has your family been affected by civil conflict or natural disasters
such as displacement, flooding, drought, fire or famine? Describe:
What type of house do you live in? Describe such as grass
thatched, iron sheet, cemented etc:
Please describe any other cause of disadvantage or vulnerability?
Any siblings in i) Secondary School:
ii) University:

(SKETCH A DIRECTIONAL MAP TO THE HOME FROM THE NEAREST LANDMARK)

Part D: How did you first learn about the Wings to Fly scholarship program?
(Please mark only one)

n Equity Bank Branch (specify location)
n Equity Agent (specify location)
n School – teacher, principal or counselor (list name)
n Church, mosque, synagogue (specify name)
n Friends, parent, guardian or relative
n Internet (specify site)
n Radio, TV (specify)
n Newspaper, magazine (specify)
n Social networks such as Facebook, Twitter, Myspace (specify)
n Others (specify): _______________________________________________________________________________________

PART E: DECLARATIONS

APPLICANT’S DECLARATION

I, _________________________________________ declare that the information given above is true to the best of my knowledge and I
am aware that giving false representation will mean that my application will not be considered and will lead to automatic disqualification.

I authorise Equity Group Foundation or its representatives to obtain such additional information concerning my educational program and financial records as needed to complete this scholarship application.

I also authorise Equity Group Foundation and its representatives to communicate and release information to others who are involved in making decisions relating to my educational plans including and not limited to my previous and future schools, referees named in this form and the Ministry of Education.

In theevent I win the scholarship, I commit myself to working hard and posting excellent results throghout my secondary school course.

Signature:
Date
D D M M Y Y Y Y

PARENT’S/GUARDIAN’S DECLARATION

I confirm that the above information is true to the best of my knowledge and I am aware that giving false representation will mean that the application will not be considered and will lead to automatic disqualification.

On behalf of my child, I authorise Equity Group Foundation or its representatives to obtain such additional information concerning this applicant’s education and financial records as
needed to complete this scholarship application.

I also authorise Equity Group Foundation and its representatives to communicate and release information to others who are involved in making decisions relating to this applicant’s educational plans including and not limited to their previous and future schools, referees named in this form and the Ministry of Education.
Parent/Guardian Name ________________________________________________________________________________________
Signature: Date D D M M Y Y Y Y
If you wish to provide additional information, please attach a separate piece of paper.

Part F: RECOMMENDATIONS

This part must be completed by the relevant authorities indicated. Any false infomation will lead to disqualification.

1. Primary School Head Teacher:
Please report on the above named applicant’s performance, conduct, special interests and talents. Also explain why he/she should be considered for the Wings to Fly Scholarship Program:

How long have you known the candidate /family? ___________________________________________________________________
My school has ______ pupils who sat for KCPE and in the most recent tests sat by the applicant before sitting for KCPE, this applicant’s position was no. ______ overall and attained ______ marks out of 500.
Report on any special interests or talents the child may have e.g. leadership, sports, arts, music etc:__________________________
Rate the candidate’s financial ability: n Very Rich n Rich n Middle Income n Poor n Very Poor
I have reviewed the information given in this form and believe it to be truthful. The above named student attended my school and based on my knowledge and/or inquiries, I affirm that he/she is needy/vulnerable. Please describe facts about his/her circumstances.
________________________________________________________________________
Signature & Official Stamp:
Date
D
D
M
M
Y
Y
Y
Y
Postal Address: P.O. Box:
Town/City:
Postal Code:
Telephobe/Mobile No.
2. Provincial Administration (Chief or Assistant Chief).
How long have you known the candidate/family? ____________________________________________________________________
Rate the candidate’s financial ability: n Very Rich n Rich n Middle Income n Poor n Very Poor
Yes
No
Orphaned
Parents/Guardians are employed
Parents/Guardians
Any additional information, explain:
I have reviewed the information given in this form and believe it to be truthful. The above named student is a resident of my location/sub-location. Based on my knowledge and/or inquiries, I affirm that he/she is needy/vulnerable.
Name:
Signature & Official Stamp:
Date