WVSU Scholarship Form C-2

(Accomplish in Duplicate)
Revised 2009

West Visayas State University

OFFICE OF STUDENT AFFAIRS
La Paz, Iloilo City

GOVERNMENT SCHOLARSHIP FORM C-2

_____ Semester, SY _____________
Date: _____________
THE PRESIDENT
This University
Sir/Madam:
May I apply for the start/continuance of my _________________________ Scholarship for the SY, ___________,
________ Semester, I have complied with all the requirements for the said scholarship. Thank you.

Very truly yours,

_________________________
Signature over Printed Name of Scholar

_________________________
Course/Year & Section

Recommending Approval:
______________________________
College Dean
Action Taken: ( ) Approved

( ) Disapproved

PROF. LEAH MAE C. CABALFIN

Dean, OSA

A.

PERSONAL DATA

Name of Student: __________________________________ Course/Year & Section: ____________ STFAP Bracket: _______
Name of Parents: ____________________________________ Age: _____ Birth Date: __________________ Gender: ______
Complete Home Address: _______________________________________________ Contact Number: ___________________
Scholarship enjoyed the previous term: ________________________________ Adviser: _______________________________
B.

ACADEMIC DATA
Subject Taken (Previous Semester)

Grade

No. of Units

Instructor

GPA: ___________Total:__________ Checked by :__________________

Section Adviser
Certified Correct:

____________________________
Director, Admissions and Records
ATTACH THE FOLLOWING DOCUMENTS
TES/UPSTEP/DOST/ISKOLAR SANG ILOILO/CHED/ILOILO CITY SCHOLARSHIP/ MUNICIPAL SCHOLARSHIP Contract/Notice of Scholarship/Certification