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OFFICE OF THE MAYOR Taguig City, Philippines L.A.N.I. SCHOLARSHIP APPLICATION FORM Instruction: 1. PRINT all entries 2.

Place an X in the appropriate blank provided Date:_____________________________ ____ New Applicant last semester

Recent 2x2 ID Picture

__X_ Renewing Scholarship: ___17____total units completed

SCHOLARSHIP APPLIED FOR ____ Basic Scholarship ____ SUCs-LCUs Scholarship ____ Full Scholarship __x_ Premier/Specialized Schools Scholarship ____ Scholarship for Priority Courses & Skills Training ____ Review Assistance Program __X_ Merit Incentive (For those with average of 1.75 or higher or its equivalent): Grade Ave: ______1.1617_________ PERSONAL INFORMATION VALLES, JO-DIA JEAN LORENANA YANGOREN (Last Name) (First Name) (Middle Name) Home Address: 254 MANUEL L. QUEZON ST., PUROK 3, NEW LOWER BICUTAN, TAGUIG CITY Full Name: Cellphone No.: 09351217186 Telephone No.: 549-6471 E-mail Address: jyvalles14@gmail.com Age: _ 17__ Gender: __F__ Marital Status: SINGLE Citizenship: _FILIPINO__ Religion: __ROMAN CATHOLIC Date of Birth: OCTOBER 14, 1995 Place of Birth: PONTEVEDRA, NEGROS OCC._ Years of Residency in Taguig: 17 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, pls provide details: ___________________________________________________________________________________________ ________________________________ Are you currently a recipient, or is applying to be a recipient of other scholarships grants? _ x_ Yes ___ No. If yes, what scholarships: __ DOST-SEI MERIT SCHOLARSHIP ___ Benefit per semester/trimester?:P __17000.00___ This scholarship is given by _______School ______ Non-Governmental Organization ______ Government (Local or Natl) ____ Private Individuals _____ Others (pls specify) ______________________________________________________________________ Are you working? ___Yes _x_ No. Where? __________________________________________ Gross monthly salary: P______________ COURSE and SCHOOL Course: _______________ BS STATISTICS __________________ Year Level: ____ 1______ Grade Ave. last sem:___ 1.1617 __ Are you graduating this sem? _X__No ___Yes If yes, are you graduating with honors? ____No ___Yes______________

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School: _____________________________ UNIVERSITY OF THE PHILIPPINES DILIMAN _________________________________ School Address: ______________ DILIMAN, QUEZON CITY ____________________________________ Bar/Board Exam To Take: _____________________________________ Exam Date: _____________________ 1st take?____ Re-take?____ EDUCATIONAL BACKGROUND School Type Schools Attended (Indicate School Address (start with most recent) if Public or Private) TAGUIG SCIENCE HIGH PUBLIC C.P. TINGA SPORTS COMPLEX,
SCHOOL HAGONOY, TAGUIG CITY

Year Graduat ed 2012 2008 2002

Honors/Award s Received (if any)


4TH HONORABLE MENTION, LEADERSHIP AWARDS

R.P. CRUZ SCHOOL

SR.

ELEM. PUBLIC PRIVATE

MANUEL L. QUEZON ST. NEW LOWER BICUTAN, TAGUIG CITY


MANUEL L. QUEZON ST. NEW LOWER BICUTAN, TAGUIG CITY

VALEDICTORIAN
ACADEMIC AWARDS

MARANATHA CHRISTIAN ACADEMY

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FAMILY BACKGROUND FATHER ( ) Living (X) Deceased FRANCISCO L. VALLES MOTHER (X) Living ( ) Deceased AMPARO Y. VALLES 549-64-71 ayangoren23@yahoo.com HUSBAND/WIFE (If Married)

Name Address Contact No. Occupation Place of Work


Highest Educational Attainment

COLLEGE GRADUATE

3RD YEAR HS

Ave. Monthly Income Residence: _______Owned by family______ Owned by relatives __X___ Renting _____Paying-to-own _____Others (pls specify): __________________________ If renting or paying-to-own, how much are you paying monthly?: P______________ Does the family have any outstanding loan? ____Yes ___ No. If yes, how much (total)? P__________________ What was the loan or loans used for? __________________________________________________________________________________________________ ___ How much is your latest monthly electric bill?: P__3,023.45___ How much is your latest water bill?: P_523.21 Number of siblings in the family (including applicant):___4___. Please fill out information below about your siblings: Ag e Name JO-ANNA JANE Y. VALLES DIANNA JANE Y. VALLES JO-DIA JEAN LORENANA Y. VALLES JEAN RICH Y. VALLES 20 19 17 14 Marita l Status (M or S) S S S S Highest If working, indicate Educational where they work & their Attainment (as of average monthly income date) BSED ENGLISH COLLEGE GRADUATE 2ND YEAR COLLEGE HS GRADUATE 1ST YEAR HS

I hereby certify that ALL the answers given above are TRUE and CORRECT to the best of my knowledge, and the attached documents are FAITHFUL REPRODUCTION of the original copies.

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I further acknowledge that ANY ACT OF DISHONESTY OR FALSIFICATION MAY BE A GROUND FOR MY DISQUALIFICATION from this scholarship program. Thank you very much. ________ JO-DIA JEAN LORENANA Y. VALLES __________ Printed Name & Signature of Applicant Date: ________________11/11/12__________________ Attested by: _______________AMPARO Y. VALLES ________________________ ________11/11/12________ Printed Name & Signature of Parent/Legal Guardian Date:
Rev:10/1/12/bel

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