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130326537 LANI Scholarship Application Form College Board Takers Rev 1-4-13

130326537 LANI Scholarship Application Form College Board Takers Rev 1-4-13

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Published by Deo Gines Lizada
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Published by: Deo Gines Lizada on May 21, 2013
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03/01/2014

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OFFICE OF THE MAYOR Taguig City, Philippines L.A.N.I. SCHOLARSHIP APPLICATION FORM For College, Tech-Voc, and Bar/Board Reviewees Only Instruction: 1. PRINT allentries 2. Place an X in the appropriate blank provided ____ New ApplicantRecent 2x2 ID PictureDate:_____________________________  ____ Renewing Scholarship: _________total units completed last semesterSCHOLARSHIP APPLIED FOR ____ Basic Scholarship ____ SUCs-LCUs Scholarship ____ Full Scholarship ____ Premier/Specialized Schools Scholarship ____ Scholarship for Priority Courses & Skills Training ____ Merit Incentive ____ Review AssistanceProgram PERSONAL INFORMATION Full Name: _______________________________________  _____________________________________________________________________________ (Last Name) (First Name) (Middle Name) Address: __________________________________  ________________________________________________________________________________  _____ Barangay: _____________________________________ E-mail Address: __________  ______________________________________ Mobile Phone No.:________________________  _______ Telephone No.: ________________________ Age: _________________ Date of Birth:______________________ Place of Birth: _____________________________ Yearsof Residency in Taguig: _________ Gender: _____ Marital Status: _________ Citizenship:_______________ Religion: ___________________________________ Have you been the object of any disciplinary action in school? ____Yes _____ No Have you been accused or convicted of any offense/crime? ____ Yes _____ No If the answer toany of the last 2 questions above is â
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Yes,â
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pls provide details: ______________________ ________________________________________________________________________________  ____________________ Are you working? ___Yes ___ No. Where? ____________________  ______________________ Gross monthly salary: P______________ COURSE and SCHOOL Course: ___________________________________________________________Year Level: __  ________ Grade Ave. last sem:_____________ Are you graduating this sem? ____No _  __Yes If yes, are you graduating with honors? ____No ___Yes______________ If no,how many semesters more to go before you graduate, including the current sem? _  ___________________________ School: ____________________________________________  _______________________________________________________________________________ School Address: ________________________________________________________________  ________________________________________________ EDUCATIONAL BACKGROUND School Type (Indicate if School Address Public or Private)Schools Attended (start with most recent)Year Started â
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Year GraduatedHonors/Awards Received (if any)Investing in education, investing in the Cityâ
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s foundation!
 
FAMILY BACKGROUND FATHER ( ) Living ( ) Deceased Name Address Contact No. Occupation Place of WorkHighest Educational AttainmentMOTHER ( ) Living ( ) DeceasedHUSBAND/WIFE (If Married)Ave. Monthly Income Residence: _______Owned by family______ Owned by relatives _  _____ Renting _____Paying-to-own _____Others (pls specify): ____________________  ______ If renting or paying-to-own, how much are you paying monthly?: P_________  _____ Does the family have any outstanding loan? ____Yes ___ No. If yes, how much (total)? P__________________ What was the loan or loans used for? ____________  ________________________________________________________________________________  _________ How much is your latest monthly electric bill?: P______________ How much is your latest water bill?: P_______________ Number of siblings in the family(including applicant):_______. Please fill out information below about your siblings: Age Name Marital Status (M or S) Highest Educational If working, indicatewhere they Attainment (as of work & their average monthly date) incomeI hereby certify that ALL the answers given above are TRUE and CORRECT to the best of my knowledge, and the attached documents are FAITHFUL REPRODUCTION of theoriginal copies. I further acknowledge that ANY ACT OF DISHONESTY OR FALSIFICATION MAY BE A GROUND FOR MY DISQUALIFICATION from this scholarship program. Thankyou very much. _____________________________________________________________ Printed Name & Signature of Applicant Date: ____________________________________________________ Attested by: __________________________________________________________________ Printed Name & Signature of Parent/Legal Guardian Date: _________________________  __ Rev:1/4/13/belInvesting in education, investing in the Cityâ

s foundation!

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