Mboho Anam Asssociation
Your Full Name
Date of birth
Sex MaleFemale
Village of Origin
Clan
Ward
Local Government Origin
Phone number
Your email
Place of birth
Name/Address of Institution
Reg No
Program
Department
Course of Study
Year of Admission
Expected year of Completion of Study
Have you ever benefited from MBOHO ANAM Bursary Award? YesNo
Date of application
Upload Passport photo *
Upload certificate of origin *
Admission letter*
Evidence of Payment of school fee*
Attestation by the Student’s Village Head*
Attestation by the Student’s Head of Department*
DECLARATION BY THE STUDENT I hereby declare that I am currently a student of the aforementioned Institution. I accept that my application may be rejected if any of the information given by me in this form is found to be false.