Tier 1 Revised Version – Enabling Girls in AI and Growing Expertise (ENGAGE) in Data Science

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Upload ENGAGE Project Parental Consent Form for Form Three Girls *

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Upload ENGAGE Project Applicant Assent Form *

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Full Name of Applicant: *

Student Admission Number *

Date of Birth (DD/MM/YYYY): *

Day

Month

Year

Age *

Are you female? *

Do you have personal Email? *

Student Email Address: *

Please provide an alternative email address where we can reach you. *

What is your Home County *

Baringo Sub Counties *

Bomet Sub Counties *

Bungoma Sub Counties *

Busia Sub Counties *

Elgeyo-Marakwet Sub Counties *

Embu Sub Counties *

Garissa Sub Counties *

Homa Bay Sub Counties *

Isiolo Sub Counties *

Kakamega Sub Counties *

Kajiado Sub Counties *

Kericho Sub Counties *

Kiambu Sub Counties *

Kilifi Sub Counties *

Kirinyaga Sub Counties *

Kisii Sub Counties *

Kisumu Sub Counties *

Kitui Sub Counties *

Kwale Sub Counties *

Laikipia Sub Counties *

Lamu Sub Counties *

Machakos Sub Counties *

Makueni Sub Counties *

Mandera Sub Counties *

Marsabit Sub Counties *

Meru Sub Counties *

Migori Sub Counties *

Mombasa Sub Counties *

Murang’a Sub Counties *

Nairobi Sub Counties *

Nakuru Sub Counties *

Nandi Sub Counties *

Narok Sub Counties *

Nyamira Sub Counties *

Nyandarua Sub Counties *

Nyeri Sub Counties *

Samburu Sub Counties *

Siaya Sub Counties *

Taita-Taveta Sub Counties *

Tana River Sub Counties *

Tharaka-Nithi Sub Counties

Trans-Nzoia Sub Counties

Turkana Sub Counties *

Uasin Gishu Sub Counties *

Vihiga Sub Counties *

Wajir Sub Counties *

West Pokot Sub Counties *

Ward *

Location *

Sub-Location *

What is the name of your village? *

Which is the nearest public primary school to your home? *

Are you a Kenyan Citizen? *

What is your Home Country

What is your immigration/residency status?

Will you be available to attend a 10-day residential training, (November 24th to December 5th 2025)? *

Attach copy of birth certificate *

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Name of current school *

School postal address *

County the School is located *

What class are you in? * Only girls in Form three will be considered *

What was your total score? in the exam at the end of the first term of 2025? *

What was your score in mathematics? at the end of the first term of 2025? *

Are you a member of any club or society?

State the name of the club? *

Name of the Principal *

Phone number of the Principal *

Attach first term 2025 academic results (stamped by the school) *

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Attach 2024 academic results (stamped by the school) *

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What motivated you to apply for the ENGAGE project?

Primary School

Name of the primary school you attended *

Primary School postal address

County the School is located *

KCPE Marks *

List of Awards/ Recognitions Received

Parent / Guardian Details:

Who do you live with? *

Father

Is your father alive? *

Full Name

Father's Phone number *

Nationality *

National ID Number *

Father's Age *

Highest education level of your father *

Father's Occupation *

Other sources specify *

Attach copy of national ID *

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Attach copy of burial permit/death certificate if deceased

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Mother

Is your Mother alive? *

Full Name *

Mother's Phone number *

Nationality *

National ID Number *

Mother's Age *

Highest education level of your mother *

Mother's Occupation *

Other sources specify *

Attach copy of national ID *

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Attach copy of burial permit/death certificate if deceased

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Guardian/Foster Parent(s)

Do you have a Guardian/Foster Parent(s)? *

Full Name *

Guardian/Foster Parent(s) Phone number *

Sex *

Relationship to applicant *

National ID Number *

Guardian/Foster Parent(s) Age *

Guardian/Foster Parent(s) Occupation *

Attach copy of Guardian/Foster Parent(s) national ID *

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Select Household monthly income range: *

Number of people living in your household: *

Number of dependents under 18 years in your household (or above 18 but currently in school): *

Number of elderly members (65+ years): *

Number of members with disabilities *

Do you have any disability or special needs? *

Describe your disability or special need

Does your family experience difficulties in meeting basic needs? *

Briefly describe the difficulties *

Have you ever deferred due to lack of school fees? *

Briefly describe the situation *

What best describes the type of structure where your family lives? *

What is the ownership arrangement of your family housing? *

If Other Explain *

Does your family own any land? *

If yes, Specify *

Sibling Details

Do you have any siblings who are currently employed /working? *

Details of employment done by siblings here

Sibling Name

Organization

Role

If Sponsor *

If "Other" Name of Sponsor *

Name of Organization *

Contact Person *

Sponsor Email Address

Sponsor Phone Number

Provide a name of a Referee (teacher, pastor, etc.) – a person who knows you and your home: *

Provide Referee contact (teacher, pastor, etc.) – a person who knows you and your home: *

Do you have any special need that should to be considered if selected for this training project? *

Please specify *

Feedback about the application experience

I declare that the information provided above is true and accurate to the best of my knowledge

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