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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
Masters 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

1 1: : I In nf fo or rm ma at ti io on n o on n P Pr ro og gr ra am mm me e o of f S St tu ud dy y
2 2: : P Pe er rs so on na al l D Da at ta a
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) Bachelors degree studies: ..
(ii) Masters degree studies..
PhD applicants must fill both (i) and (ii)

3: Evidence of Identity
4 4: : Career Details


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Form NM-A102

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I wish to seek NM-AISTs 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
5 5: : Application for Scholarship
6: Declaration



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