APPLICATION FORM

OFFICE OF CONGRESSMAN BENJAMIN D. ASILO

"TULONG NI ATONG SA MGA MAG-AARAL NG TUNDO" QUALITY EDUCATION FOR ALL PROGRAM
Fill up this form (IN PRINT) and submit to the Office of Congressman together with other required documents
NAME: ____________________________________
(SURNAME)
(NICKNAME)
SEX: ______

_______ _________________________
(FIRST NAME)

____________________________________
(MIDDLE NAME)

AGE: _______ BIRTHDAY: ______________________ BIRTHPLACE:___________________________________________________________________

ADDRESS: _______________________________________________________________________BRGY: ___________________ TEL/CEL No: ____________________

FACEBOOK ACCOUNT: _________________________________OTHER USER NAME: _____________________________

(Note: Confidentiality in using other user name will strictly be observed by this office)

PRESENTLY LIVING WITH (check one)

Relationship (if guardian/others) ____________________________

( ) Parents ( ) Guardian ( ) Others

SCHOOL: ___________________________________________________ YEAR LEVEL: ________________

COURSE: ___________________________ (check one)
( ) 5 year course ( ) 4 yr course ( ) 3 yr course ( ) 2 yr course
FATHERS NAME: ______________________________________ _________________________________
(SURNAME)
(FIRST NAME)

___________________________
(MIDDLE NAME)

OCCUPATION: ____________________________________ PLACE OF WORK: _______________________ AGE: _____ BDAY: _____________

MOTHERS NAME: ______________________________________ _________________________________
(SURNAME)
(FIRST NAME)

___________________________
(MIDDLE NAME)

OCCUPATION: ____________________________________ PLACE OF WORK: _______________________ AGE: _____ BDAY: _____________

NAME OF BROTHER/s /SISTER/s

1.
2.
3.
4.
5.

AGE

BIRTHDAY

SCHOOL/WORK

New Applicant _________

Old Apllicant: __________
(pls. indicate kung anong year kayo nagstart as scholar and kindly check kung anong semester)
1ST Year
School Year _________
1ST SEM _____
2ND SEM _____
2ND Year School Year _________
1ST SEM _____
2ND SEM _____
3RD Year School Year __________
1ST SEM _____
2ND SEM _____
4TH Year School Year __________
1ST SEM _____
2ND SEM _____
OTHERS: ____________________

AGREEMENT UNDER THE PROGRAM, "TULONG NI ATONG SA MGA MAG-AARAL NG TUNDO"

1. APPLICANT AND HIS / HER PARENT / GUARDIAN MUST BE RESIDENTS OF TONDO 1
2. KNOWS HOW TO OPEN, OPERATE AND USE THE COMPUTER.
3. MUST BE FAMILIAR IN USING FACEBOOK
4. MUST VISIT OR LOG ON TO FACEBOOK (tahanangmasa_ctc@yahoo.com ,/, whizzhouse@ymail.com) ONCE A WEEK.
5. WILLING TO RENDER COMMUNITY SERVICE IN THEIR OWN BARANGAY,
6.. WILLING TO RENDER SERVICES OUTSIDE THEIR BARANGGAY (TONDO/MANILA).
7. MUST POSSESS THE CHARACTER OF A GOOD STUDENT AND HAVE DESIRE TO FINISH STUDIES.
8. KINDHEARTED AND CARING TO PARENTS
9. HINDI PA GRANTEE O NAG-APPLY SA ANUMANG INSTITUSYON, SIMBAHAN, PAARALAN O IBA PA.,
10. IF POSSIBLE, NO BODY MARKINGS (TATTOO BOTH BOYS AND GIRLS AND NO EARINGS (BOYS)
11. Isa lang sa magkapatid ang pwedeng mag-aaply sa ating programa.

_________________________________________________
PARENT / GUARDIAN SIGNATURE

_____________________________________
SIGNATURE OF APPLICANT