2021 MCFSP AT KNUST APPLICATION FORM

2021
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MASTERCARD FOUNDATION SCHOLARS PROGRAM AT KNUST

SCHOLARSHIP APPLICATION FORM (2021/2022 ACADEMIC YEAR)
PS: YOU NEED TO APPLY FOR KNUST ADMISSION SEPARATELY FIRST TO HAVE ANY CHANCE FOR THIS SCHOLARSHIP.

INSTRUCTIONS:

1. Students awaiting results are not eligible to apply.

2. Attach a copy of your WASSCE/Senior High School Certificate to this application form. (You would be
required to present the original copy of your certificate in person if you are finally selected). Please note

2021
that you must have your High School Certificate as at the time of making this application. Therefore,
your results must not be more than five years old at the time of application.
3. WASSCE/SSSCE Applicants must have credits (A1-C6/A-D Respectively) in the following Three (3) Core
Subjects: English Language, Mathematics, and Integrated Science plus credits (A1-C6/A-D) in Three
Elective Subjects with an Aggregate Score of 24 or better in the relevant Area of Study.
4. Provide three (3) reference letters signed and sealed independently by 3 persons of high reputation
from
a. Your High school (Head or Assistant Head),
b. Religious groups (certified Christian Minister or Imam) and
c. Community (Chief or Community Leader).
Reference letters can also be obtained from other individuals with high repute outside the above-
stated groups.
5. Provide evidence of the estimated income of parents/guardian. E.g. Copies of the payslips of your
parents/guardian. (if applicable) or monthly income from the job they do.
6. Attach high school transcripts/terminal reports covering each year in school.
7. Attach a copy of your birth certificate.
8. Attach any other relevant documents that you believe will support your application.
9. International applicants are expected to have passports ready for onward travel to Ghana should their

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application be successful. (Attach a copy of the bio data page of your valid passport if you already
have one).
10. Applicants must apply to KNUST separately. Applicants are to note that the completion of this
application form does not constitute an application to KNUST for admission.
11. Completed application form should be sent via courier ONLY (EMS/DHL/Fedex) to the following
address:
The Program Manager,
Mastercard Foundation Scholars Program at KNUST,
℅ Office of the Dean of Students,
PMB, KNUST, Kumasi, Ghana.
Please Note:

You do not qualify to apply if you are either presently enrolled in any tertiary institution or have completed one. If you
are found to have provided any false information, you would be dismissed from the Program.

Applicants are advised to DESIST from calling the MCF Scholars Program at KNUST Secretariat and Program staff to
inquire of the status of their application. The Secretariat would inform and contact applicants as and when necessary.

Applicants are also to note that the ENTIRE APPLICATION PROCESS IS FREE and MCFSP at KNUST has no intermediaries.
Applicants who make payments to individuals and organizations in relation to this application process do so at their
own risk.

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 2021 MCFSP AT KNUST APPLICATION FORM

SECTION A

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Student Information

Surname____________________________________
First Name_______________________ Middle/Other names________________________________
Gender: M F Date of Birth (DD/MM/YYYY): ____/____/________ Age: ________
Nationality___________________________ Country of birth _________________________
Native Language _______________________
Marital Status: Single Married Separated Divorced
Do you have children Yes No If yes, how many children do you have? _______
Telephone number 1. _____________________ 2. ________________________
Emergency number_____________ (Please provide a contact number that can easily be reached at all times)
Postal Address_______________________________________________________________

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Current Residence (Region)__________________________ E-mail Address:________________________
Permanent Residence _________________________________ Hometown: ________________________
Skype ID_________________________________ Do you have a passport? Yes No
Displaced Persons/Persons with Disability NB: This information will not be used against you in the
selection process; It is to assist the Program provide the necessary assistance you would need once your
application is successful)

a. Do you have any form of disability (eg. Hearing, mobility, vision, speech, etc.)? Yes 0 No 0

If yes, briefly describe the form of disability:

_______________________________________________________________________________________
_______________________________________________________________________________________

How long have you been living with this disability? _____________________________________________
(Please attach evidence of your disability eg. Medical records, photographs)

b. Are you a displaced person (Certified Refugee, Internally Displaced person (IDP), etc.)? Yes 0 No 0

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(Please attach evidence of your status as a refugee or IDP eg. ID card or letter from a recognized body in charge of
displaced people)

If yes, how long have you been living as a displaced person? ______________________________________
(Please attach the necessary supporting documents)

Information on Your Undergraduate Admission at KNUST

Please list the order of your choice of programmes you want to read at KNUST.

1st choice:

2nd choice:

3rd choice:

4th choice:

NB: Note that KNUST admission processes is separate from this form. Applicants are therefore
required to Submit an Application to KNUST before they can be considered for this scholarship.

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 2021 MCFSP AT KNUST APPLICATION FORM

SECTION B

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Educational Background

Please write the names of the institutions you have attended in the following order (or the equivalence
of the level as indicated below);

DATE DATE CERTIFICATE

NO. INSTITUTION/SCHOOLS ATTENDED
COMMENCED COMPLETED OBTAINED

1 Name of Primary School(s):

Public Private
2 Name of Junior High School(s):

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Public Private
3 Name of Senior High School(s):

Public Private
4 Name of Tertiary Institution(s):

Public Private

SECTION C
Parent Information

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Please provide the following information on your parents.

Mother Father
Full Name______________________________ Full Name_______________________________
Country of Residence__________ Age_______ Country of Residence____________ Age______
Nationality_____________________________ Nationality______________________________
Employer’s Name_______________________ Employer’s Name__________________________
Job Title_______________________________ Job Title________________________________
Highest level of Education_________________ Highest level of Education__________________
Check the box if not alive Check the box if not alive
Number of siblings (NB: this refers to the children of either your mother or father or both): ______

Mother and father are Living together

Separated
Divorced
Remarried

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SECTION D

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Family Information
NB: “Family” under this section refers to ‘a group of two or more people (one of whom is the householder)
related by birth, marriage, or adoption and residing together; all such people are considered as members of
one family’.
“Householder” refers to the head of the household.

1. How many people, including yourself, depend on the income of your parents/householder for daily
living? ______ . (Is the head of your household your biological parent? Yes No

2. How many people including yourself, depend on the income of your parents/householder for their
educational cost? ______ .

3. a. Complete the table below for all members of your family/household living in your householder’s
home (including yourself) and indicate their status:

Status (Student / Working /

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No. Full Name Age Relation to you
Unemployed)
1
2
3
4
5
6
7
8
9
10

b. Complete the table below for other members of your family/household living in your householder’s
home. If member is employed give details as to the nature of employment. Employment type may

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include Farmer, Teacher, Trader, Nurse etc.
No. Full Name Employment Details Highest Level of Education
1
2
3
4
5
6
7
8

4. Have you or any of your siblings ever missed a significant part of a school term due to lack of finances?
Yes No If yes, please explain and attach evidence (if any):
________________________________________________________________________________
________________________________________________________________________________
_______________________________________________________________________________

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5. Family/Householder’s Financial Details:

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a. Please provide details for your family’s monthly income from all sources:

GH₵___________ from mother GH₵____________ from father

GH₵___________ from other relative GH₵____________ from other sources

TOTAL MONTHLY INCOME___________________

b. List other sources of your family’s income coming from other relatives:

No. Name Relation to you Amount Frequency (How often)

1
2
3
4

6. Do you expect any significant change in your family or household income in the coming year? If yes,

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please explain why:
________________________________________________________________________________________
________________________________________________________________________________________
__________________________________________________________________________________

7. Tell us to the best of your ability, how much your family/household spends per month to meet its living
expenses. Specific categories are provided below.

GH₵___________ for rent or mortgage GH₵___________ for food

GH₵___________ phone bills (Call cards & Data) GH₵___________ for public transportation
GH₵___________ for medical bills GH₵___________ for electricity bills
GH₵___________ other expenses (specify)___________________________________

TOTAL MONTHLY EXPENSE___________________

SECTION E

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Educational Expenses
1. How much does your family spend on the education of the members of your family/household per year?
No. Full Name Name of School Level/Stage School Fees Other Cost
1
2
3
4
5
6
7

2. Are your fees paid by a relative other than your householder? Yes No
What is the relation between you and this person? ____________________________
How many other children’s fees are paid for by this same person: __________________

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SECTION F

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(NB: for applicants whose education is/was sponsored by others either than parents/householder)

Sponsor Information

1. Please provide the following information on each sponsor of your education (other than your parents).
This may include institutions or organizations that have sponsored your education.

Name________________________________ Name________________________________
Relationship to the applicant_________________ Relationship to the applicant__________________
Country of Residence____________ Age_______ Country of Residence____________ Age_______
Employer’s Name___________________________Employer’s Name___________________________
Job Title_________________________________ Job Title_________________________________
How regular was this sponsorship? How regular was this sponsorship?
Monthly Monthly
Termly Termly

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Annually Annually

2. Were you on any bursary/scholarship? Yes No

Bursary/Scholarship was provided by ___________________________________________

If so, how much did the bursary/scholarship cover? ________________________________

3. Have you applied for any form of financial sponsorship for your tertiary education?

Yes No

If yes, please list the sponsorship/s you have applied for:

1 4
2 5
3 6

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SECTION G
House Information

1. a. Please tick the type of accommodation that you and your family occupy;

Parent’s House
Family/Householder’s House
Rented premises paid for by my parent’s employer
Rented premises paid for by parent
Other (Specify)

Number of bedrooms in your dwelling place; ________________

Number of rooms you occupy with your family; ________________

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b. Describe the dwelling in which you live including the location (where in the city, in rural
village, etc.) and types of appliances and amenities.

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_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________

Type of Construction Material: Mud

Brick
Cement
Wood
Other (Please specify)

Roofing material of dwelling: Metal

Thatch
Other (Please specify)

Type of toilet facility: Flush or pour flush toilet

VIP latrine

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Uncovered pit latrine
Composite toilet
No facility/bush/field
Ecosan
Other (Please specify)

Do you share the toilet facility with other households? Yes No

What type of flooring material do you have in your house: Mud

Wood
Tile
Cement

Do you have running water in your house? Yes No

2. Do you know how to use/operate the following? Tick all that may apply.

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a. Mobile Phone Yes No b. Computer Yes No

c. Internet Yes No d. A Car Yes No

3. Does your family have the following at your residence?

a) Refrigerator: Yes No
b) Television: Yes No
c) Satellite Dish: Yes No
d) Electric Iron: Yes No
e) Desktop Computer: Yes No
f) Laptop Computer: Yes No
g) Internet Access: Yes No
h) Electricity Access: Yes No
i) Phone Yes No
j) Motorcycle Yes No
k) Bicycle Yes No

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4. Does your family own a motor vehicle? Yes No

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If yes, list the year, make (e.g., Honda, Toyota) and model (e.g., Civic, Prado, Corolla) of each vehicle.

__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________

Is it a private vehicle or Commercial Vehicle?

SECTION H
Leadership, Community Engagement and Vision

a) Write a brief statement outlining your personal and academic goals. (100-word maximum)

__________________________________________________________________________________
__________________________________________________________________________________

2021
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
_________________________________________________________________________________

b) In your own words, what is your understanding of community; briefly explain.

__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________

c) Describe your involvement and the outcome of one significant community leadership initiative in

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which you played a role (to be validated by one of the persons providing your recommendation
letters). (100-word maximum)

__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________

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d) Provide a list of current and past leadership positions, extra-curricular activities or experiences.

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Kindly attach relevant certificates or documents.

Title/Activity/Experience Dates Primary Responsibilities

e) Describe a time when you identified a need in your community and took action.

i. What need did you identify?

2021
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________

ii. How did you address this need?

__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________

iii. What difficulties did you encounter?

__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________

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__________________________________________________________________________________
__________________________________________________________________________________

iv. What was the outcome?

__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________

f) Do you see any challenge(s) in your community? Yes No

If YES, please list some of them:

1. _______________________________________________________________________
2. _______________________________________________________________________
3. _______________________________________________________________________
4. _______________________________________________________________________
5. _______________________________________________________________________

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g) What is your vision for your community? (250 Word limit)

2021
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________

h) How will achieving a Bachelor’s degree education at KNUST and participation in the Mastercard
Foundation Scholars Program empower you to address challenges in your community? (100-word

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maximum)

__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________

i) In a few words, describe your strengths, gifts, and areas you consider there is the need for growth.

__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________

DECLARATION

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I hereby declare that the information herein given is a true and accurate account of my status. The
Foundation reserves the right to revoke my status as a Scholar of the Program at any time and take
the necessary legal action and sanctions against me if the information given is found to be inaccurate.

………………………………... ………………….…
Signature of Applicant Date

__________________________________________________________________________________
Below should be endorsed by: (your Pastor/Imam/Headmaster/Headmistress/Chief/a Leader in
your community).

I know the applicant for (how long?) ___________ and can vouch that all the information given by
him/her is credible.

Name: __________________________________________________

Status: __________________________________________________

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

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Give a vivid description of the directions to your place of residence (WHERE YOU LIVE WITH YOUR

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HOUSEHOLD) beginning from the DISTRICT CAPITAL; include a diagram with some landmarks giving
directions to your place of residence.

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Please indicate your Ghana Post GPS (E.g. AK-315-0149) …………………………………………

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SECTION I

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I (TO BE COMPLETED BY PARENT/LEGAL GUARDIAN – person so far responsible for financing the
education of the applicant)
1. Please provide the following information:
Surname____________________________________
First Name_______________________ Other names________________________________
Marital Status: Single Married Separated Divorced
Telephone number _____________________ Email address: ____________________
Postal Address_______________________________________________________________
Residential Address_____________________________
Employment status: Employed Self Employed Retired Unemployed

Occupation Name and address of employer:

2021
Annual Total Income (GH¢): ___________________________________________________
(Salary and income from other sources. Please substantiate with a recent official salary slip, pension slip
or audited financial statement. If unemployed, please attach a sworn affidavit and declare how you
survive and your sources of funds for survival).
(Please note that this information is necessary and if not provided Mastercard Foundation Scholar
Program at KNUST will not process the application).

Other sources of income:

Pension:
Investment interest:

2021
Income from rent:
Contributions from other sources:
Earnings from taxi, passenger cars, corn mill, farming activities, petty trading, remittances from family
members etc.:

2. What is your relationship to the applicant?

Father Mother Uncle Aunt Brother Sister
Other (Specify): ___________________________________________________

3. What is your highest level of Education? (Indicate by ticking)

Tertiary Middle School

Senior High School (Secondary) Primary School
Junior High School (JSS) No Formal Education

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4. Please tick the type of accommodation that you and your family occupy.

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Own House
Family/Householder’s House
Rented premises paid for by the employer
Rented premises paid for by self
Other (Specify)

5. Provide information on your dependants.

Name Relationship Age Educational level

Indicate total amount paid in fees and other related expenses per year for dependants at each level of

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education and provide proof of current attendance (Attach school bills and receipts):

Number of Dependants Total amount paid in

Level of Education Attending school at this level the last year (GH¢)

II (TO BE COMPLETED BY SECOND PARENT/LEGAL GUARDIAN)

Surname____________________________________
First Name_______________________ Other names________________________________
Marital Status: Single Married Separated

2021
Telephone number _____________________
Postal Address_______________________________________________________________
Residential Address____________________________
Level of education _____________________________

Employment status: Employed Self Employed Retired Unemployed

Occupation: ____________________________

Other sources of income:

Pension:
Investment interest:
Income from rent:
Contributions from other sources:
Earnings from taxi, passenger cars, corn mill, farming activities, petty trading, remittances from family
members etc.:

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DECLARATION TO BE SIGNED BY BOTH PARENTS OR GUARDIANS

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It is important that your dependant’s eligibility for the scholarship be based upon accurate information.

I do hereby declare that all the information given above is true.

Signature or thump print of parent/legal guardian Date

Signature or thump print of second parent/legal guardian Date

2021
__________________________________________________________________________________

FOR OFFICIAL USE

Receipt of Application

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Name of Officer _______________________________________________________________
Signature, Official Receipt stamp with date ( )

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