20

25
APPLICATION
FORM
FOR ENTRY IN JANUARY 2026

THIS FORM IS NOT FOR SALE

TO BE FILLED ONLY BY CANDIDATES CURRENTLY IN GRADE 9
NB: The completion and submission of this application is not a guarantee for Sponsorship

Name of Applicant (As it appears on the birth certificate)

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Index Number..................................................................................................................................................................................
Gender...............................................................................................................................................................................................
Home County...................................................................................................................................................................................
Name of Primary School ..............................................................................................................................................................
Primary School Postal Address....................................................................................................................................................
County Where Primary School is Located................................................................................................................................

APPLICATION DEADLINE
30TH APRIL 2025
SCAN THE CODE TO
ACCESS THE Developing Transformational Leaders Through Innovative Approaches To Education.
FORM ONLINE P.O Box 7954 – 01000 Thika, Kenya I Telephone: +254 (0) 703 200 000 I Email: [email protected] | www.mpesafoundationacademy.ac.ke
 NAME OF APPLICANT....................................................................................................................

This form is given FREE by the M-PESA Foundation Academy. Any persons attempting to charge money for it should be reported to the
nearest police station or call 0703200000.

Dear Applicant,
We are excited that you are applying to the M-PESA Foundation Academy. This
admission cycle targets learners who will sit for their Grade 9 Kenya Junior School
(Mandatory) Education Assessment (KJSEA) in November 2025. Successful applicants will join
Affix a clear passport
photograph here the Academy in January 2026 for a three-year residential (boarding) programme
(Showing the head to study the CBC Senior Secondary Curriculum. Applicants must be at least 14 and
and shoulders) not more than 16 years of age at the time they are expected to join the Academy.
taken no more than
The Academy is an inclusive learning environment, and students with SEND
three months ago.
(Special Education Needs & Disability) are encouraged to apply.

Before you begin filling out the application form, please read the information below carefully.

Instructions

1. Please fill out the 2025 application form, as clearly and completely as possible. Please note that the more information you
make available to us, the better it is for us to evaluate your application. Forms from previous years WILL NOT be accepted.
2. Attach copies of the following documents, failure to which your application WILL NOT be considered;

a.Birth Certificate.
b.Parent/Guardian ID.
c.Parent Death Certificate, where applicable.
d.Academic reports for the Grade 6(KPSEA certificate), 7 & 8 (Internal assessments). Only reports downloaded from the
KNEC portal and stamped with an official school stamp will be accepted.
e.Evidence of leadership and Co-curricular activity certificates.
f. Payslip of Parent/Guardian if employed.
g.Any other document deemed relevant.

3. Write your first and last name in capital letters at the top of each page as it appears on your Birth Certificate in
case the pages detach.
4. Applications should be enclosed in a sealed envelope during submission.
5. Online applications are encouraged. Ensure the application is scanned and attached as a single PDF document.
6. Note that admission into the M-PESA Foundation Academy will be based on an independent application process
separate from the national Grade 9 application and selections process.
7. All responses MUST be written in the spaces provided within the form and filled by the student applying for the scholarship
using his/her own handwriting. You are NOT allowed to insert any extra pages.
8. Only Complete Applications will be considered.
9. Note that only shortlisted candidates will be contacted.
10. Any omission of the above will lead to automatic disqualification
11. We will verify all the information provided in this application form.

Important Dates

Application deadline is 30th April 2025 Application forms received after 30th April 2025 will not be considered.

You can get application forms in any of the following ways:

•Online on www.mpesafoundationacademy.ac.ke
•Physical copies are available at ;
-MPESA Foundation Academy, THIKA.
-Safaricom Retail Shops, Countrywide.
-SAFARICOM Headquarters, Westlands.

Submission of Application Forms

Selection: Applications will be evaluated on the
Drop off/Submit your applications in one of the following ways: following criteria
•Email to; [email protected] A. Academic Excellence.
•Post to; B. Financial Need.
M-PESA Foundation Academy C. Leadership potential
P.0 Box 7954-01000, Thika. D. Potential in Creativity, Innovation & Entrepreneurship
•Drop off at any Safaricom Retail Shop. E. Desirable values, discipline & behaviour.
F. Critical Thinking and Problem Solving Skills.

1 The completion and submission of this application is not a guarantee for Sponsorship
About us
The M-PESA Foundation Academy is a state of the art, co-educational high school institution currently offering International
Baccalaureate (IB) curriculum. The Academy intends to introduce the Competency-Based Curriculum (CBC), Senior Secondary in
the year 2026; and it is well equipped to offer all the three CBC pathways namely:

1) Arts and Sports science

2) Social Sciences
3) Science Technology Engineering and Mathematics (STEM)

Driven by leadership, entrepreneurship, technology and innovation, the Academy serves talented but economically
disadvantaged students with demonstrated leadership potential. The school is located in Thika West Sub- County, Kiambu County
and it admits learners from all the 47 counties in Kenya on full high school scholarship.
Our Vision
To develop transformational leaders who strive for excellence and success for themselves, their communities and their world.
Our Mission
As a leadership development institution, we will deliver an innovative world class education through a holistic curriculum so
that our learners are principled, reflective and open-minded. Through our programmes, we will nurture active, compassionate
and successful life-long learners.

Core Values
(CLAIRE)
We are invested in and take
ownership of our teaching and
learning in order to constantly
grow. Curiosity

We have the courage to

challenge the status quo in
Leadership order to inspire and lead
positive change.

We hold ourselves and others

responsible for decisions, Accountability
attitudes and actions taken.

We see problems in our

Innovation communities as opportunities
for transformative action.

We value compassion and

care for those around us as
we contribute to the common Responsible
good. Citizenship

We are exceptional people

Excellence committing to personal and
shared achievement.

Excellence

Academics
The Academy will offer each of the CBC pathways with an emphasis on practical skills, critical thinking and real world problem
solving. Students will be assessed through continous assessment tests, practical projects and prepare them for national exams,
that will prepare them for tertiary education, vocation training or entry into the job market. Through the careers department, the
students are guided on their pathways and exposed to a wide range of career choices to make.

Student Life and Pastoral Care

The Student Life Department caters for students’ life outside the teaching curriculum. Their physical and psychological well-being
is guaranteed. A highly nutritious diet is provided to all learners. We offer learners opportunities to nurture their leadership skills
and grow their talents. Students are attached to internal and external mentors who prepare them for life after school. Child
safeguarding and protection procedures have been put in place to protect learners from harm within and outside of the
Academy.

Tertiary Education Support

We support the transition of the Academy’s graduates by equipping them with the necessary skills that empower them to create
a better tomorrow by offering a bespoke life skills pre-university curriculum, that supports our learners for life after high school
and life in general.

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 NAME OF APPLICANT....................................................................................................................
A: APPLICANT’S PERSONAL DATA
First Name Middle Name Last Name NEMIS Number

Date of Birth (Attach copy of (dd/mm/yyyy) Gender (tick appropriate) Religion:

Birth Certificate)
__ __/__ __/__ __ __ __ MALE / FEMALE

Do you have any

If YES, give a brief explanation below and attach copies of medical
condition that requires YES / NO
certificates.
special support?

Are you a citizen of Kenya? If NO, state:

YES: 1. Your country of citizenship........................................................................................................

NO: 2. Your residence in Kenya ............................................................................................................

B: PRIMARY SCHOOL DETAILS (MANDATORY)

Name of School County School Phone Number School Postal Address

Head Teacher’s First Name Head Teacher’s Last Name Head Teacher’s Phone Number Head Teacher’s Email

Permanent physical address of School

(Include name of Estate/ Village and sub-county)

School Type (tick appropriate) Public Private Religious Informal

CBC PATHWAYS: Arts and Sports Science Social Sciences Science, Technology, Engineering,
and Mathematics (STEM)
(Tick any two)

C:PARENT /GUARDIAN INFORMATION (MANDATORY)

Is your Father Alive: Is your Mother Alive Are you under the care of a guardian
YES_______ NO________ YES_______ NO________ YES_______ NO________

FATHER MOTHER GUARDIAN

FULL NAME (as is in

your ID)

State your relationship

with the applicant
(attach death
certificate or burial
permit if parent is
deceased).

Country of citizenship
(If not Kenyan)

National ID number
(Attach a copy)

Parent’s/ Guardian’s
Employer

Family
(married/single/divor
ced/widowed)

Permanent physical
home address (State
the exact location by
estate/ village name
& nearest landmark
e.g. school, church,
mosque, hospital

D. SIBLING INFORMATION (BROTHERS AND SISTERS) MANDATORY

NAME AGE OCCUPATION INCOME INSTITUTION/SCHOOL WHO PAYS

3 The completion and submission of this application is not a guarantee for Sponsorship
NAME OF APPLICANT....................................................................................................................

FINANCIAL DECLARATION BY PARENT/ GUARDIAN (MANDATORY)

Provide the information needed here as truthfully as possible. Note that the Management of MPESA Foundation Academy
reserves the right to withdraw the scholarship and ask your child to leave the Academy if it is discovered that the information
provided here was falsified. Attach Bank statements /payslip/ Mpesa statement as evidence of your financial status.

FATHER OR GUARDIAN 1 MOTHER OR GUARDIAN 2

Briefly describe how you earn your daily/ monthly

income.

What is your estimated monthly gross income in Kenya Shillings?

Please tick your appropriate range of gross monthly income (from employment and/or self-employment e.g. business or casual labour)

Over 100,000 51,000 - 100,000 31,000 - 50,000 16,000 - 30,000 5,000 - 15,000 Below 5,000

What kind of house do you live in? Please tick the most appropriate descriptions from this list.

OWNED Permanent (3 or
more bedroom)
Permanent
(1-2
Semi Permanent (wooden/ Temporary (wooden/ iron Informal/ grass
mud & cement floor) sheet houses without thatched houses
bedroom) cement floor)

Over 25,000 16,000 - 25,000 11,000 - 15,000 6,000 - 10,000 Below 5,000
RENTED
(monthly rent of)

What is the economic status of your neighbourhood/ estate/ village?

Upper Class Middle Class Middle Class Ordinary Urban Working Working Class Rural Informal Urban
Urban estate Urban Estate Rural Estate Class Estate Settlements/Rural Poor

If your child does not get this scholarship, in which category of school will you afford to educate him/her?

International Private Schools National Extra County Public County Public Day Public Schools
Schools (National Public Schools Schools Schools
curriculum)

FATHER OR GUARDIAN 1

First Name Last Name

Signature Date __ __/ __ __/ __ __ __ __

(dd/mm/yyyy)

Telephone Number Email

MOTHER OR GUARDIAN 2

First Name Last Name

Signature Date __ __/ __ __/ __ __ __ __

(dd/mm/yyyy)

Telephone Number Email

The completion and submission of this application is not a guarantee for Sponsorship 4
 NAME OF APPLICANT....................................................................................................................
SECTION TO BE STRICTLY FILLED BY THE STUDENT (PLEASE WRITE ON THE SPACE PROVIDED)
Application Essays MUST be written by the applicant without any assistance from anybody else. Any assistance, will
lead to Automatic disqualification of your application.

1. a. What has inspired you to apply for this scholarship?

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b. Discuss the contribution you would make to your community if you are awarded this scholarship
(Write providing as much detail as possible within the space provided below)
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2. Scenario: You have been elected as the president of the Environmental Club in your school and you have been
tasked to organise an activity on climate change in your community. Describe the activity and how you would
organise the club members to conduct it.
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5 The completion and submission of this application is not a guarantee for Sponsorship
 NAME OF APPLICANT....................................................................................................................
CLASS TEACHER’S ENDORSEMENT ON TALENT, INNOVATION, ENTREPRENEURSHIP AND LEADERSHIP POTENTIAL
List any outstanding activities that the applicant has been involved in over the last two years. These could include
entrepreneurial and innovation activities, sports, drama, arts, clubs, leadership etc
(Assist the applicant to attach copies of certificates where available).

ACTIVITY NUMBER OF YEARS COMMENT ON LEVEL ACHIEVED

NAME: Signature: Contact: Date:

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RECOMMENDATION BY HEADTEACHER OR DEPUTY HEADTEACHER OF CURRENT SCHOOL

(TO BE FILLED OUT ONLY BY THE HEADTEACHER OR DEPUTY HEADTEACHER OF SCHOOL THE APPLICANT IS CURRENTLY ATTENDING)

1. How long has the student been in your School?

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2. Comment on the applicant's behaviour.

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3. Comment on the applicant’s family financial status?
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4. Comment on the applicant's academic ability? Kindly attach the applicant’s Academic reports for Grade 6, 7 & 8.
Only Reports downloaded from the KNEC portal and stamped with an official school stamp will be accepted.
SEE THE SCREENSHOT BELOW OF A SAMPLE REPORT DOWNLOADED FROM KNEC PORTAL.
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SECTION MUST BE SIGNED AND STAMPED USING THE OFFICIAL SCHOOL STAMP. By signing below, you are indicating that you have reviewed
the information provided in this application (including the class teacher’s endorsement) and confirm its accuracy.

NAME: Signature: Date (dd/mm/yyyy)/ Official Stamp:

………………………………………………………………… …………………………………… __ __/ __ __/ __ __ __ __

SAMPLE ASSESSMENT REPORT

6
 NAME OF APPLICANT....................................................................................................................

RECOMMENDATION BY EITHER SUB-COUNTY DIRECTOR OF EDUCATION, CHIEF, PRIEST, PASTOR OR IMAM

Last Name First Name

Office Phone Mobile Phone

Permanent physical address COUNTY

(Estate/ Village, sub-county)

Postal Address Email Address

Based on your knowledge and/or inquiries you have made, why would you recommend this applicant to M-PESA
Foundation Academy? (Use the space below for your response and sign and certify)

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Please sign to indicate that you have read through this application confirms the accuracy of the information provided.

Signature: Date (dd/mm/yyyy)/ __ __/ __ __/ __ __ __ __

________________________ OFFICIAL STAMP

DECLARATIONS:
Applicant’s Declaration

I declare that the information given above is true to the best of my knowledge. I authorise MPESA Foundation Academy
to obtain & verify such additional information concerning my academic and any other records as needed to complete
this scholarship application.

Applicant Name……....................………….................….......... Signature………..........………Date…………………...............………

Parent/Guardian Declaration

I confirm that the above information is true to the best of my knowledge and I am aware that giving false information will
mean that the application will not be considered. On behalf of my child, I authorise Mpesa Foundation Academy to
obtain & verify any additional information concerning this applicant. I authorise the academy to obtain any education
and financial records from government bodies and any other organisation or institution as relevant to complete this
scholarship application.

Parent/ Guardian Name……....................………….................….......... Signature………..........………Date…………………………

MANDATORY: ATTACH A DETAILED MAP TO YOUR HOMESTEAD FROM THE NEAREST TOWN. The Map MUST be drawn on
an A4 Size photocopy paper highlighting the KEY LANDMARKS such as Rivers, Hospital, Schools e.t.c

DISCLAIMER: Kindly note that the completion and submission of this application is not a guarantee for Sponsorship.
Due vetting and interview process will be followed. Due to the large number of applications we receive every year only
shortlisted applicants are contacted.