OFFICE OF THE MAYOR

Taguig City, Philippines

Recent
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L.A.N.I. SCHOLARSHIP APPLICATION FORM

Instruction:
1. PRINT all entries
2. Place an X in the appropriate blank provided
____ New Applicant

Date:_____________________________

____ Renewing Scholarship: _________total units completed last semester

SCHOLARSHIP APPLIED FOR

____ Basic Scholarship
____ SUCs-LCUs Scholarship
____ Full Scholarship
____ Premier/Specialized Schools Scholarship
____ Scholarship for Priority Courses & Skills Training
____ Review Assistance Program
____ Merit Incentive (For those with average of 1.75 or higher or its equivalent):Grade Ave: _____________________
PERSONAL INFORMATION
Full Name: ____________________________________________________________________________________________________________________
(Last Name)
(First Name)
(Middle Name)
Home Address: _______________________________________________________________________________________________________________
Cellphone No.:________________________ Telephone No.: ___________________ E-mail Address: ________________________________
Age: ________ Gender: _____ Marital Status: _________ Citizenship:_______________ Religion: ___________________________________
Date of Birth:______________________ Place of Birth: _______________________________ Years of Residency in Taguig: _________
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? ___ Yes ___ No. If yes,
what scholarships: _________________________________________________ Benefit per semester/trimester?:P ____________________
This scholarship is given by _______School ______ Non-Governmental Organization ______ Government (Local or Natl)
____ Private Individuals _____ Others (pls specify) ______________________________________________________________________
Are you working? ___Yes ___ No. Where? __________________________________________ Gross monthly salary: P______________
COURSE and SCHOOL
Course: ___________________________________________________________Year Level: __________ Grade Ave. last sem:_____________
Are you graduating this sem? ____No ___Yes
If yes, are you graduating with honors? ____No ___Yes______________
School: ___________________________________________________________________________________________________________________________
School Address: ________________________________________________________________________________________________________________
Bar/Board Exam To Take: _____________________________________ Exam Date: _____________________ 1st take?____ Re-take?____

Schools Attended
(start with most recent)

EDUCATIONAL BACKGROUND
School
Type
(Indicate if
School Address
Public or
Private)

Year
Graduated

Investing in education, investing in the Citys foundation!

Honors/Awards
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
Residence: _______Owned by family______ Owned by relatives ______ 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______________ How much is your latest water bill?: P_______________
Number of siblings in the family (including applicant):_______. Please fill out information below about your siblings:
Age
Name

Marital
Status
(M or S)

Highest Educational If working, indicate where they

Attainment (as of work & their average monthly
date)
income

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. 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.
_____________________________________________________________
Printed Name & Signature of Applicant
Date: __________________________________________
Attested by:

__________________________________________________________________
Printed Name & Signature of Parent/Legal Guardian

Date: ___________________________

Investing in education, investing in the Citys foundation!

Rev:10/1/12/bel