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Basic-SUC-LCU-Basic SCU-LCU. Application Form SY 2015-2016. Rev 3.8.15
Basic-SUC-LCU-Basic SCU-LCU. Application Form SY 2015-2016. Rev 3.8.15
Recent
2x2
ID Picture
_____ SUC/LCU
_____ Renewing Applicant
Semester: _____ 1st Sem
that
you
have
benefitted
the
2nd
Sem
Scholarship:
PERSONAL INFORMATION
Name:
_________________________________________________________________________________________
_______________________
(Last Name)
(First Name)
(Middle
Name)
Address:
_________________________________________________________________________________________
____________________
Barangay: _________________________________________ Years of Residency in Taguig
(applicant): _________
Mobile/Landline Phone Numbers:_________________________________________________
Age: _________________
Place of Birth: ____________________________________
Date
of
Birth:___________________________________________
Gender: ____________
Marital Status: ____________
Religion:
________________________________________________
E-mail
Address:
______________________________________________________________________________
Residence: _____Owned by family _____Owned by relatives _____Renting ____Paying-toown
_____Others (pls specify): _________________________________________________
If renting or paying-to-own, how much are you paying monthly?:
P_________________________
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 to any of the last 2 questions above is Yes, please provide details:
_________________________________________________________________________________________
_______________________________
EDUCATIONAL BACKGROUND
Course:
_________________________________________________________________________________________
______________________
Year Level: _______ Graduating this semester? _____Yes _____No
Grade Ave. last
sem:_______________
Regular duration of Course: _____5 years _____4 years _____3 years _____2 years
_____Others
(specify)
____________________________________________________________
How many semesters more to go before you graduate, including the current sem/term?
_________________
School:__________________________________________________________________________________
______________________________
School
Address:
_________________________________________________________________________________________
____________
Name of Schools
Graduated From
High School:
Elementary:
School
Type
(Indicat
e if
Public
or
Private)
School Address
(Barangay and
City/Municipality)
Year
Started
Year
Graduat
ed
Honors/Award
s Received
(if any)
FAMILY BACKGROUND
FATHER
( ) Living ( )
Deceased
MOTHER
( ) Living ( )
Deceased
HUSBAND/WIFE
(If Married)
Name
Address
Contact No.
Occupation
Place of
Work
Highest
Educational
Attainment
Ave.
Monthly
Income
Number of siblings in the family (including applicant):___________________. Please fill out
information below about your siblings:
Age
Marit
Highest
If
working,
indicate
al
Educational
where they work &
Name
Statu
Attainment
their average monthly
s
(M
(as of date)
income
or S)
I hereby certify that ALL the answers given above are TRUE and CORRECT to
the best of my knowledge and that the attached documents are faithful reproduction of
the original copies. I further acknowledge that ANY ACT OF DISHONESTY OR
FALSIFICATION
MAY
SERVE
AS
A
GROUND
FOR
MY
PERPETUAL
DISQUALIFICATION from this Scholarship Program.
I also understand that this submission of application does NOT automatically
qualify me for the scholarship grant and that I will abide by the decision of the L.A.N.I.
Scholarship Management.
Thank you very much.
_____________________________________________________________________________
_______________________________
Printed Name & Signature of Applicant
Date
Attested by:
_____________________________________________________________________________
______________________________
Printed Name & Signature of Parent/Legal Guardian
Date
Rev.3.8.15