University of the Philippines Application for Financial Assistance under the Socialized Tuition and Financial Assistance Program

(STFAP)
Alphabetic Bracketing Scheme
UP STFAP Form AB-1 Version 1.06 03/09

This form may be photocopied or downloaded from the U.P. STFAP website: http://stfap.up.edu.ph. Printed forms are available for a nominal amount. To qualify for financial assistance, the student must: 1. Be a Filipino citizen. 2. Be a bona fide undergraduate student. Except for Law or Medicine, the applicant must not have a bachelors degree. For an incoming freshman or new student, the applicant must have a U.P. Admission Slip. 3. Never have been adjudged guilty of any offense that carries a penalty of more than thirty- (30) days suspension. 4. Be in need of financial assistance as determined by the University. Important Notes 1. The grant shall be for one academic year, renewable annually. 2. The University reserves the right to determine whether the student deserves financial assistance, and the kind and amount of assistance. 3. STFAP privileges will be withdrawn from a student who withholds and/or falsifies information, without prejudice to other penalties that may be imposed by the University. Some students have already been expelled or suspended from the University for withholding and/or falsifying information in their STFAP application. 4. All information supplied by the student will be treated with strict confidentiality and will be for the internal use only by the University.

Part A.Instructions and Checklist Instructions 1. This application form is for use in the manual application process. If you want to apply online, access STFAP Online at http://stfap.up.edu.ph. 2. The application form must be filled out by the student and the parent/legal guardian/ spouse. 3. Print all entries legibly. Place a check mark or a cross inside the box of the appropriate response. 4. Avoid erasures. For each erasure, the applicant must countersign the item corrected on the page margin. 5. Answer all questions and fill up all items. If the question requires a numerical response and the answer is None, write 0. When the question is not applicable to your situation, write NA. Do not leave any item blank. 6. Attach photocopies of the documents/materials in the following checklist to your accomplished application form. Present the originals of the documents for verification when you submit your application. Non-submission of applicable documents/materials may be considered withholding of information. 7. Submit the accomplished application to the designated student affairs office of your constituent university/campus on or before the deadline. Checklist of Required Documents/Materials 1. One (1) 2 2 picture taken within the last three months, with the applicants name and student number printed on the back, stapled on Page 3 of this form. 2. Birth certificate of the applicant. 3. Income Tax Return (ITR) of the applicant for the previous year, if employed. 4. Income Tax Returns of the applicants parents/legal guardian/spouse for the previous year. If unemployed or exempt, submit the BIR Certification of Exemption from non-filing of ITR or Municipal Certification of Unemployment. 5. Income Tax Returns of other gainfully employed members of the applicants household for the previous year. 6. Affidavit of support from legal guardian, if applicable. 7. Marriage certificate if the applicant is married. 8. Personal Statement of Assets and Liabilities of the applicants parent/legal guardian/ spouse. Use Page 12 of this application form. 9. Latest Tax Declarations of all real properties. 10. Assessment form or statement of account or certification from high school regarding the amount of school fees paid by the applicant for fourth year high school (for private high schools only). 11. Assessment form or statement of account or certification from college/university regarding the amount of school fees paid by the applicant prior to entering U.P. (for transferees only). 12. Electric bills for the last three (3) months. 13. Water bills for the last three (3) months.

STFAP Application No.: ______ Academic Year 20__-20__ Part B.Application Form 1. Student Data 1.1. 1.2.

STFAP Use Only: CU/Campus: ________ Date Received: Received by: ___________________

2 2 Picture Print name and student number on the back and staple here

U.P. Student Number: 20__-_____

Students Name: Family Name: _________________________ First Name: ________________________________________ Middle Name: _______________________ Maiden Name? No Date of Birth: Month: ___ Sex: Citizenship: Civil Status: Male Filipino Single Day: ___ Year: ___

Yes

1.3. 1.4. 1.5. 1.6. 1.7.

Female Other, please specify: Married __________________

Separated/Divorced Widowed

Address of Student While at U.P.: Street Address: _______________________________________ Barangay: ________________________________________ City/Municipality: ________________________________________ Province: ________________________________________ Zip Code: ____ Students Telephone Number: Landline: _______________ Cell phone: _______________ Students e-mail Address: ______________________________

1.8.

1.9. 1.10.

Name and Address of Parent/Legal Guardian/Spouse: Name: _______________________________________ Street Address: _______________________________________ Barangay: ________________________________________ City/Municipality: ________________________________________ Province: ________________________________________ Zip Code: ____ Telephone Number of Parent/Legal Guardian/Spouse: Landline: _______________ Cell phone: _______________ Students Permanent Address: (if different address from 1.7 or 1.10) Street Address: _______________________________________ Barangay: ________________________________________ City/Municipality: ________________________________________ Province: ________________________________________ Zip Code: ____
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1.11.

1.12.

1.13.

Type of financial assistance applied for: Bracket C: 40% tuition subsidy Bracket D: 70% tuition subsidy Bracket E1: 100% tuition, miscellaneous and laboratory fees subsidy Bracket E2: 100% tuition, miscellaneous and laboratory fees subsidy, semestral stipend High School Data: Name of high school: ___________________________________________ Address: _______________________________________________________ Type of high school: Public general U.P.-administered Public special (science high school) Other state university high school Public vocational Private sectarian Public barrio/barangay Private non-sectarian Tuition and other school fees paid in fourth year high school: P__________ Were you on scholarship in high school? No Yes Are you a transferee from a non-U.P. school? No Yes How much did you pay as school fees in your last semester/trimester/quarter in your previous school? P__________ Were you on scholarship in your previous school? No Yes College Data: U.P. campus: Baguio Manila Cebu Mindanao Diliman San Fernando Iloilo / Miag-ao Tacloban / Palo Los Baos College: ______________________ Degree Program: __________________________ Year Level:

1.14.

1.15.

1.16.

1 2 3 4 5

What is your student type? Freshman / Transferee from non-U.P. school Old student, first-time STFAP applicant Old student, previous STFAP applicant (Alphabetic Bracketing Scheme) What was your previous STFAP bracket? ___ Have you been suspended for at least 30 days anywhere in the U.P. system? No Yes 1.17. Do you have a brother/stepbrother/sister/stepsister/spouse enrolled in an undergraduate program anywhere in the U.P. System?
Student Number Civil Status Applying for STFAP this Year? Yes No

Name

Campus

College

1.18.

Are you staying in a boarding house or dormitory? No Yes Are you staying in a U.P. dormitory? No Yes How much is your monthly board? P_______ Monthly lodging? P_______ How do you travel between U.P. and your current place of residence? By family/own vehicle By carpool By motorcycle By public transport How much is your transport fare per day? P_______ By bicycle/walking Are you currently employed? No Yes Are you employed: Full time? Part time? If you worked last year, what was your annual gross income? P__________ Who will finance your schooling? Parents Relatives Self Scholarship other than STFAP, please specify: ______________________ How much do you receive as support per semester? P__________ Educational plan, please specify: ________________________________ How much do you receive as support per semester? P__________ Others, please specify: ________________________________________ How much do you receive as support per semester? P__________ Are your parents, legal guardian, or your spouse a member of the following? No membership in any organization Sports and country club (e.g., Manila Polo Club, Makati Sports Club) Service organization (e.g., Lions Club, Rotary) Professional association (e.g., Integrated Bar of the Philippines, Philippine Institute of Civil Engineers) Business organization (e.g., Makati Business Club, PCCI) Others, please specify: ______________________ Have you been issued a passport? No Yes What is your passport number? ________ Date issued? ________ Have you traveled outside the Philippines within the last two years? No Yes How many times have you traveled abroad within the last two years? ___ Who financed the trip(s)? Family Others

1.19.

1.20.

1.21.

1.22.

1.23.

2. Family/Household Data Household is defined as all persons living under the same roof and/or sharing food and other expenses. 2.1. Who among the following family members are co-residing with you? Father/Stepfather Mother/Stepmother Legal Guardian Spouse Children Number: _____ Brothers/Stepbrothers Number: _____ Sisters/Stepsisters Number: _____ Others Number: _____ Total members of your family co-residing with you: _____ 2.2. Parents/Legal Guardian/Spouse
Educational Attainment Type (see code list next page) School Attended or Graduated From Occupation Group (see code list next page) Previous Years Gross Income Previous Years Income Taxes Paid Still Living?
Yes, Living Abroad?

Name Father/Stepfather Mother/Stepmother Legal Guardian Spouse

Age

Name of Employer

Yes

No

No

2.3.

Other family or household members who are employed or earning.

Relationship to the Applicant Educational Attainment Type (see code list below) School Attended or Graduated From Occupation Group (see code list below) Previous Years Gross Income Previous Years Income Taxes Paid Currently Living with Your Family?
No, Working Abroad?

Name of Family or Household Member Who Is Employed

Age

Name of Employer

Yes

No

Yes

Educational Attainment Type Codes: (choose the highest applicable) G Masters or doctorate degree holder CG College graduate C Attended college but not graduated HG High school graduate H Attended high school but not graduated EG Elementary school graduate E Attended elementary school but not graduated N Never attended school

Occupation Group Codes: M Government official, corporate executive, manager, managing proprietor, supervisor P Professional: accountant, dentist, doctor, engineer, lawyer, teacher T Technician C Clerk W Sales worker, farmer, forestry worker, fisherman, trade worker, plant and machine operator, assembler, laborer, unskilled worker O Other occupation U Unemployed

2.4.

Non-earning brothers/stepbrothers/sisters/stepsisters who are single and living with the family. For married applicants, include children. Use a separate sheet if necessary.
Name Age Relationship to the Applicant Studying? Yes No Educational Attainment Type (see code list above) School Attended or Graduated From With Scholarship? Yes No

2.5.

Other relatives or people who contribute in meeting the family expenses.

Name Relationship to the Applicant Type of Contribution Average Monthly Contribution

2.6.

What are the sources of income of your household? (select all that apply) Business Remittances from abroad Practice of profession Commissions Farms/haciendas/fishponds Earnings from investments Real estate rentals Pensions Salaries or wages Others How many of the following are living with or working full-time for your family? Number Housemaid ___ Houseboy ___ Yaya ___ Cook ___ Driver ___ Gardener ___ Security guard ___ Others, please specify: __________________ ___ Does your family have any of the following? Include only those that are in good working condition and have been purchased or acquired by your family within the last ten (10) years. Number of working units AM/FM Radio ___ Stereo/audio system ___ Karaoke ___ Piano/organ/electronic keyboard ___ Cell phone Television set Video player (e.g., DVD/VCD player, VHS player) Video camcorder Wood/charcoal/kerosene stove LPG stove Electric stove LPG cooking range with oven Electric cooking range with oven Microwave oven Refrigerator Upright or chest-type freezer Washing machine Heated electric clothes dryer Air conditioner Electric water pump and tank Electric water heater Desktop personal computer Notebook/laptop personal computer Computer game system (e.g., Sony PlayStation) ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___

2.7.

2.8.

2.9.

Do you have telephone landlines? No Yes How many landlines?

___

Do you have electricity? No Yes How much were your electricity bills for the last three months? Month: _______________ Amount of bill: P________ (attach copy of bill) Month: _______________ Amount of bill: P________ (attach copy of bill) Month: _______________ Amount of bill: P________ (attach copy of bill) Do you have piped or running water inside the house? No Yes How much were your water bills for the last three months? Month: _______________ Amount of bill: P________ (attach copy of bill) Month: _______________ Amount of bill: P________ (attach copy of bill) Month: _______________ Amount of bill: P________ (attach copy of bill) Do you have a cable or satellite television subscription? Do you have an Internet service subscription? 2.10. No No Yes Yes

What is the classification of the house your family is staying in? Owned, not mortgaged Owned, mortgaged Monthly amortization: Rented Monthly rental: Rent free / Living with relatives Others, please specify: ______________________

P________ P________

2.11.

What is the approximate floor area (in square meters) of the house your family is staying in? ________ sq. m How many bedrooms do you have? ___ How many toilets and bathrooms do you have? ___ Do you have flush toilets? No Yes Do you have a swimming pool? No Yes Which of the following are owned by your family? How many? Year and Model Sports utility vehicle (e.g., Honda CR-V) ___ ________________________ Car or van ___ ________________________ Asian utility vehicle (e.g., Toyota Revo) ___ ________________________ Pickup truck (e.g., Mitsubishi Strada) ___ ________________________ Owner-type jeep ___ ________________________ Truck ___ ________________________ Passenger jeepney ___ ________________________ Motorcycle ___ ________________________ Tricycle ___ ________________________ Does your father/stepfather/mother/stepmother/legal guardian/spouse have credit card(s)? No Yes What type of credit card? American Express Locally issued (e.g., HSBC MasterCard, PNB Visa, BPI Express Credit)

2.12.

2.13.

2.14.

What real estate properties are owned by, or registered in the name of, your family? Residential Lots Area (in sq. m) ____________ ____________ ____________ Location (Municipality/City, Province) _________________________________ _________________________________ _________________________________ Market Value P____________ P____________ P____________

Do you earn income from these residential lots? No Yes How much per month? P________ Non-Residential Lots / Agricultural Lands Area (in sq. m) ____________ ____________ ____________ Location (Municipality/City, Province) _________________________________ _________________________________ _________________________________ Market Value P____________ P____________ P____________

Do you earn income from these non-residential lots or agricultural lands? No Yes How much per month? P________ 2.15. What buildings and/or houses are owned or rented out to others by your family?
Floor Area (in sq. m) Location (Municipality/City, Province) Monthly Rental Market Value

________ ________ ________

____________________________ ____________________________ ____________________________

P_________ P__________ P_________ P__________ P_________ P__________

Do you have boarders, lodgers, or bedspacers? No Yes How much is your total monthly income from boarding, lodging, or bedspacing? P________ 2.16. Are there special circumstances in your family which may help the University evaluate your financial need? No Yes State briefly the circumstances below:

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3. Vicinity Map of the Family Residence Please indicate landmarks in your sketch.

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Personal Statement of Assets and Liabilities of Parents/Legal Guardian/Spouse I, ______________________________________, of legal age, single/married and a resident of _____________________________________________________, hereby state: 1. That my familys assets and liabilities as of 31 December 20__, are as follows: (a) Assets Personal Properties Savings Stocks/Investments Vehicles Jewelry Furniture Appliances Others Total Personal Properties Real Properties Residential lands Non-residential lands Residential buildings Non-residential buildings Total Real Properties Total Assets (b) Liabilities P ________________ ________________ Total Liabilities (c) Net Worth (a) (b) Total Assets less Total Liabilities P ________________ P ________________ Cost P ________________ ________________ ________________ ________________ ________________ ________________ ________________ P ________________ Market Value P ________________ ________________ ________________ ________________ P ________________ P ________________

2. That this personal statement is made to support the application for financial assistance under the STFAP of _______________________________________.(name of student). Date: ____________ ______________________________________ Printed Name of Parent/Legal Guardian/Spouse ______________________________________ Signature of Parent/Legal Guardian/Spouse

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Part C.Statements 1. Statement of the Applicant I hereby certify, upon my honor, that all the data and information that I have furnished are accurate and complete. I understand that any misinformation and/or withholding of information will automatically disqualify me from receiving any financial assistance or subsidy and may serve as grounds for my expulsion or disciplinary action from the University. In addition, if such misinformation and/or withholding of information on my part is discovered after I have been awarded the financial assistance or subsidy, I will be required to reimburse all the financial benefits received plus interest at the legal rate prevailing at the time of reimbursement without prejudice to the filing of charges against me. Moreover, I authorize the University to conduct a bank credit investigation and send a fact-finding team to visit my home/residence to verify the veracity and accuracy of the information provided in this application or to obtain additional information on my capacity to pay and I will give my utmost cooperation in this regard. For the purpose of said verification, I further authorize the fact-finding team to use still/digital camera and other means to record the actual conditions or circumstances of our family. I understand that my refusal to comply with any of the above-mentioned conditions may mean suspension or withdrawal of STFAP benefits and privileges. Date: ____________ __________________________ Signature of Applicant

2. Statement of the Applicants Parent/Legal Guardian/Spouse I hereby certify that I have read the entire application form and that I certify to the truthfulness and completeness of the information that my son/daughter/dependent/ spouse has furnished in this application together with all the documents attached. I understand that any misinformation and/or withholding of information will automatically disqualify him/her from receiving any financial assistance or subsidy and may serve as grounds for his/her expulsion or disciplinary action from the University. I further recognize that in signing this application form, I share with my son/daughter/dependent/ spouse the responsibility for the truthfulness, accuracy, and completeness of the information supplied herein. Moreover, I authorize the University to conduct a bank credit investigation and send a fact-finding team to visit my home/residence to verify the veracity and accuracy of the information provided in this application and I will give my utmost cooperation in this regard. For the purpose of said verification, I further authorize the fact-finding team to use still/digital camera and other means to record the actual conditions or circumstances of our family. I understand that my refusal to comply with any of the above-mentioned conditions may mean suspension or withdrawal of STFAP benefits and privileges of my son/daughter/dependent/spouse. Date: ____________ ______________________________________ Printed Name of Parent/Legal Guardian/Spouse ______________________________________ Signature of Parent/Legal Guardian/Spouse
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Acknowledgment

REPUBLIC OF THE PHILIPPINES

) S.S. )

BEFORE ME, a Notary Public for and in the above jurisdiction, this _____ day of ______________, 20__, personally appeared ____________________________________ (name of parent/legal guardian/spouse) with Community Tax Certificate No. ___________ issued at ______________________ on ____________________, and _______________________ (name of student if applicable), with Community Tax Certificate No. ___________ issued at ______________________ on ____________________, known to me to be the same person(s) who executed the foregoing instrument and acknowledged to me that the same is their/his/her true act and deed. IN WITNESS WHEREOF, I have hereunto set my hand and seal on the date and place herein above stated.

NOTARY PUBLIC Until December 31, 20__ Doc. No. _______ Page No. _______ Book No. _______ Series of 20__

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