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 bachelor’s 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 STFAP privileges will be withdrawn from a student who withholds and/or falsifies information, without prejudice to other penalties that may be imposed by the University.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.

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

1.4.2.  Female  Other. STFAP Use Only: CU/Campus: ________ Date Received: Received by: ___________________ 2” × 2” Picture Print name and student number on the back and staple here U. 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: _______________ Student’s Permanent Address: (if different address from 1.: ______ Academic Year 20__-20__ Part B. .3.Application Form 1. 1.10.8. 1.11. please specify:  Married __________________  Separated/Divorced  Widowed Address of Student While at U.12.1.: Street Address: _______________________________________ Barangay: ________________________________________ City/Municipality: ________________________________________ Province: ________________________________________ Zip Code: ____ Student’s Telephone Number: Landline: _______________ Cell phone: _______________ Student’s e-mail Address: ______________________________ 1.STFAP Application No.P.9. Student Number: 20__-_____ Student’s 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. 1.5.7.6.7 or 1. 1. 1.10) Street Address: _______________________________________ Barangay: ________________________________________ City/Municipality: ________________________________________ Province: ________________________________________ Zip Code: ____ 3 1.P. 1. Student Data 1. 1.

P. campus:  Baguio  Manila  Cebu  Mindanao  Diliman  San Fernando  Iloilo / Miag-ao  Tacloban / Palo  Los Baños College: ______________________ Degree Program: __________________________ Year Level: 1.13.P.P. miscellaneous and laboratory fees subsidy  Bracket E2: 100% tuition. first-time STFAP applicant  Old student.14. Do you have a brother/stepbrother/sister/stepsister/spouse enrolled in an undergraduate program anywhere in the U. 1.17. school  Old student. 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.1. System? Student Number Civil Status Applying for STFAP this Year? Yes No Name Campus College 4 . 1 2 3 4 5 What is your student type?  Freshman / Transferee from non-U.P. semestral stipend High School Data: Name of high school: ___________________________________________ Address: _______________________________________________________ Type of high school:  Public general  U. Type of financial assistance applied for:  Bracket C: 40% tuition subsidy  Bracket D: 70% tuition subsidy  Bracket E1: 100% tuition.-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.P. 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.16. miscellaneous and laboratory fees subsidy. 1.15. system?  No  Yes 1.

1.g.P. Makati Sports Club)  Service organization (e.g.19. what was your annual gross income? P__________ Who will finance your schooling?  Parents  Relatives  Self  Scholarship other than STFAP. Integrated Bar of the Philippines.g. PCCI)  Others.P. Lions Club.18. 1.21.23.g. Philippine Institute of Civil Engineers)  Business organization (e. 5 .. Rotary)  Professional association (e. 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.. Manila Polo Club.22. please specify: ______________________ How much do you receive as support per semester? P__________  Educational plan. 1.. or your spouse a member of the following?  No membership in any organization  Sports and country club (e. please specify: ________________________________ How much do you receive as support per semester? P__________  Others. dormitory?  No  Yes How much is your monthly board? P_______ Monthly lodging? P_______ How do you travel between U. Makati Business Club. Are you staying in a boarding house or dormitory?  No  Yes Are you staying in a U. 1. legal guardian.. 1.20. 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. please specify: ________________________________________ How much do you receive as support per semester? P__________ Are your parents.

Family/Household Data Household is defined as all persons living under the same roof and/or sharing food and other expenses.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. 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 Year’s Gross Income Previous Year’s Income Taxes Paid Still Living? Yes.2.2. Living Abroad? Name Father/Stepfather Mother/Stepmother Legal Guardian Spouse Age Name of Employer Yes No No 6 . 2.

unskilled worker O Other occupation U Unemployed 2. For married applicants.5. Other family or household members who are employed or earning. include children. corporate executive. 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. doctor. forestry worker. engineer. Name Relationship to the Applicant Type of Contribution Average Monthly Contribution 7 . farmer. managing proprietor. Other relatives or people who contribute in meeting the family expenses. Relationship to the Applicant Educational Attainment Type (see code list below) School Attended or Graduated From Occupation Group (see code list below) Previous Year’s Gross Income Previous Year’s Income Taxes Paid Currently Living with Your Family? No. laborer. teacher T Technician C Clerk W Sales worker. Non-earning brothers/stepbrothers/sisters/stepsisters who are single and living with the family. trade worker. lawyer.3. 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 Master’s 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. manager. Use a separate sheet if necessary.2. assembler. dentist. supervisor P Professional: accountant.4. plant and machine operator. fisherman.

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..6.g. Sony PlayStation) ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ 2.g.. Number of working units AM/FM Radio ___ Stereo/audio system ___ Karaoke ___ Piano/organ/electronic keyboard ___ Cell phone Television set Video player (e. 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. DVD/VCD player. 8 .8. 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.7.2. 2.

12.g... 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..13. please specify: ______________________ P________ P________ 2.9.. Toyota Revo) ___ ________________________ Pickup truck (e. BPI Express Credit) 2. Honda CR-V) ___ ________________________ Car or van ___ ________________________ Asian utility vehicle (e.2.g.11. What is the approximate floor area (in square meters) of the house your family is staying in? ________ sq.g. 9 . HSBC MasterCard. 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.  No  No  Yes  Yes What is the classification of the house your family is staying in?  Owned.10. not mortgaged  Owned. mortgaged Monthly amortization:  Rented Monthly rental:  Rent free / Living with relatives  Others. 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.g. PNB Visa. 2.

15. or bedspacers?  No  Yes How much is your total monthly income from boarding.16. or registered in the name of. 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. Province) Monthly Rental Market Value ________ ________ ________ ____________________________ ____________________________ ____________________________ P_________ P__________ P_________ P__________ P_________ P__________ Do you have boarders. m) Location (Municipality/City.14. m) ____________ ____________ ____________ Location (Municipality/City. or bedspacing? P________ 2. your family? Residential Lots Area (in sq. m) ____________ ____________ ____________ Location (Municipality/City. What real estate properties are owned by.2. 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. Are there special circumstances in your family which may help the University evaluate your financial need?  No  Yes State briefly the circumstances below: 10 . lodging. What buildings and/or houses are owned or rented out to others by your family? Floor Area (in sq. lodgers.

Vicinity Map of the Family Residence Please indicate landmarks in your sketch.3. 11 .

Personal Statement of Assets and Liabilities of Parents/Legal Guardian/Spouse I. hereby state: 1. 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. Date: ____________ ______________________________________ Printed Name of Parent/Legal Guardian/Spouse ______________________________________ Signature of Parent/Legal Guardian/Spouse 12 . single/married and a resident of _____________________________________________________. That this personal statement is made to support the application for financial assistance under the STFAP of _______________________________________.(name of student). of legal age. ______________________________________. That my family’s assets and liabilities as of 31 December 20__.

upon my honor. For the purpose of said verification.Part C. 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. 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. if such misinformation and/or withholding of information on my part is discovered after I have been awarded the financial assistance or subsidy. 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. In addition. I share with my son/daughter/dependent/ spouse the responsibility for the truthfulness. 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. 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: ____________ ______________________________________ Printed Name of Parent/Legal Guardian/Spouse ______________________________________ Signature of Parent/Legal Guardian/Spouse 13 . I further recognize that in signing this application form. 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. and completeness of the information supplied herein. accuracy. that all the data and information that I have furnished are accurate and complete. Date: ____________ __________________________ Signature of Applicant 2. Moreover. Moreover. 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.Statements 1. 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. Statement of the Applicant’s 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 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. Statement of the Applicant I hereby certify.

and _______________________ (name of student if applicable). personally appeared ____________________________________ (name of parent/legal guardian/spouse) with Community Tax Certificate No. I have hereunto set my hand and seal on the date and place herein above stated. _______ Series of 20__ 14 . 20__ Doc.S. 20__. IN WITNESS WHEREOF. ) BEFORE ME. No. a Notary Public for and in the above jurisdiction. with Community Tax Certificate No. ___________ issued at ______________________ on ____________________. NOTARY PUBLIC Until December 31. 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. this _____ day of ______________. ___________ issued at ______________________ on ____________________. _______ Page No. _______ Book No.Acknowledgment REPUBLIC OF THE PHILIPPINES ) S.

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