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Please attach
Two (2)
FORM – 1 Passport-size
(Revised: 2009) Photographs Here
NOT FOR SALE

APPLICATION FOR THE IDB

SCHOLARSHIP

I INFORMATION ABOUT THE APPLICANT: (PRINT/ WRITE LEGIBLY)

1. Name in full (not initials) ___________________________________________________

First Name Middle Name Last Name (Family)
2. Nationality _____________ 3. Cultural Tribe Affiliation ___________________________

4. Date of birth __________________ 5. Place of birth _____________________________

6. Home address ___________________________________________________________

7. Mailing address __________________________________________________________

8. Contact Number _____________________ 9. Email Address _____________________

II INFORMATION ON THE APPLICANT’S FATHER AND MOTHER OR GUARDIAN

RESPONSIBLE FOR YOUR EDUCATION.

10. Name __________________________________________ 11. Age ________________

12. Highest education obtained _____________________ 13. Occupation ______________

14 Position _________________________15 Monthly Net Income ____________________

16. Name of Office/address ___________________________________________________

17. Number of children _____ 18. The Applicant is __ st, __ nd, __rd, __th or __ th __ child

19 Home address ___________________________________________________________

20. Contact Numbers (Landline or Mobile Nos.) ____________________________________

III EDUCATIONAL QUALIFICATIONS:

Name of the Institution/address and course obtained Year Obtained

21. College (Course) __________________________________________ _____________

High School ______________________________________________ _____________

Arabic Education __________________________________________ _____________

(Madrasah Last Attended)

22. Final grades / Higher School / “A” Level

Examination in the following subjects: (**)

Subjects Grades/Marks Subjects Grades/Marks

English (E) _______________ Chemistry (CH) _______________

Maths (M) _______________ Biology (BIO) _______________
Science (SC) _______________ Others (OTH) _______________
 Page 1 of 5

IV FAMILY PROFILE

Sibling (including you):

Highest Educational attainment of siblings:

Enrolled / Enrolled/ Enrolled/ Enrolled/ Enrolled/
Name: Graduated Graduated Graduated Graduated Graduated
Post Graduated College High School Elementary Kindergarten
Nursery
1.

2.

3.

4.

5.

6.

7.

8.

10.

11.

12.

________________________________
Signature with printed name of applicant
Date: ___________________________

Page 2 of 5
V Please write on the space below a brief essay on HOW YOU EXPECT TO CONTRIBUTE TO
THE DEVELOPMENT OF YOUR COMMUNITY AND COUNTRY UPON GRADUATION (you
may use an additional page if necessary):

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

VI To be completed by an applicant for whom the IDB will seek a placement in one of its
member countries:

The IDB Scholarship is offered mainly for Medicine and Engineering but the following areas of
study are also included: Pharmacy, Nursing, Nutrition, Veterinary, Dentistry, Medical Technology,
Agriculture, Food Technology, Forestry and Fishery. (If Engineering is chosen, the branch of
Engineering preferred must be mentioned as well.)

My preference is for ____________________________ but I will agree to study in any of the

above fields accepted by the University and recommended by the IDB.

____________________________
Applicant’s Signature

VII Declaration of the Applicant:

I hereby declare that I fully understand the objectives and the spirit of the IDB Scholarship
Programme and certify that all information given in these Application Forms and the attached
documents are complete and correct.

DATE: / /14 _________________________

/ /20 Applicant’s Signature
 Page 3 of 5

Attachment-1

DECLARATION BY THE APPLICANT TO COMPLY WITH THE IDB SCHOLARSHIP RULES AND
REGULATION

I, ______________________________, the undersigned and the applicant for a scholarship

from the Islamic Development Bank, having read the information and regulations pertaining to the
Programme, promise, promise to fully comply with the rules and regulations of the IDB Scholarship
Programme and do hereby declare that:

• My parents / guardians are not in a financial position to support my university education;

• I am not in receipt of any other scholarship from any other body / organization and nor will I take
any other scholarship while benefiting from the IDB Scholarship Programme;
• As long as I am under the IDB Scholarship Programme, I will devote full time to my education
and will not take any work, remunerated or not, that will interfere with my study;
• During my study, I will regularly inform the IDB and Muslim Community that recommended me of
my examination results, transcripts and financial receipts;
• Once I have completed my study, I will return to my community / country and will assist the
development of my community and country.

DATE: /14____/20 ____ _____________________

(Applicant’s Signature)

CERTIFICATION OF THE APPLICANT’S DECLARATION

BY A RECOGNIZED MUSLIM ORGANIZATION

I, ___________________________________(name), the undersigned, on behalf of the Muslim

Community,______________________________________(name of Organization),in the City
of_____________________, ______________________(Country) do hereby certify that the student,
________________________________ (name), applying for a scholarship from the Islamic
Development Bank, a Muslim of good conduct and high moral Character, has signed, in front of me, the
Declaration to Comply with the IDB Scholarship Rules and Regulations (Form –2 ), willingly and without
any undue pressure from any person or party and promised to uphold the tenets of Islam and apply
them in his/her daily life.

Name:_____________________________________ Position: ________________________________

Address:____________________________________________________________________________

Signature: __________________________

Date: / / 14 ________ : / / 20__________

ENDORSEMENT BY THE COUNTERPART OF THE IDB SCHOLARSHIP PROGRAMME OR A

CONTACT DESIGNATED BY THE IDB

The above statements are made by the applicant and the so named recognized Muslim
Organization as stated.

MS. MARILOU RABE-GUERRA

General Coordinator
IDB Scholarship Programme in the Philippines

Page 4 of 5
 Attachment-2

DECLARATION OF INTENT TO REFUND

I, _________________________________ (name), the student in the city / town of

________________________________________(country), applying for the IDB Scholarship do hereby
solemnly declare that after the completion of my study, I shall refund the whole amount of scholarship
and other funds received from the Islamic Development Bank during my study, to a Trust Fund (Waqf)
created by the Muslim community in my country or to any Organization / Body named by the IDB.

________________________
Date: / /4_____ Applicant’s Signature
/ /20_____

WITNESSES:

1. Name: __________________________________________________________________________

Signature: _______________________________________________________________________

Home Address: ___________________________________________________________________

Relationship to the Applicant: ________________________________________________________

2. Name: __________________________________________________________________________

Signature: _______________________________________________________________________

Home Address: ___________________________________________________________________

Relationship to the Applicant: ________________________________________________________

CERTIFICATION BY THE MUSLIM ORGANIZATION ON THE ABOVE DECLARATION

The Muslim Organization, _____________________________ (name), in the City / Town of

______________________, _________________________________ (country), certifies that the above
student signed the Declaration of Intent to Refund (Form-3) in our presence, willingly and without any
undue pressure from any person or party.

Official Stamp
of the Organization

DATE: / / 14 __ ______________________________________
/ / 20 __ Name/ Position/ Signature of Authorized Official
of Muslim Organization

Page 5 of 5
 ANNOUNCEMENT
The Islamic Development Bank (IDB) through its Counterpart Organization (CPO) in the Philippines, the Autonomous Region in
Muslim Mindanao (ARMM) under the leadership of Regional Governor DATU ZALDY UY AMPATUAN, is pleased to announce the opening
and receiving of application for scholarship grants for Muslim students for Year 1430 Hijra (Academic Year 2009 - 2010). The Program is
geared towards the development of Muslim communities in non-member countries of IDB around the world by providing scholarships to poor
but deserving Muslim students in the form of an INTEREST-FREE LOAN a “STUDY NOW PAY LATER” program that will partly cover the
grantees’ cost of living, clothing, books, tuition fees, and medical expenses.

1. QUALIFICATIONS:
1. Must not be more than 24 years old;
2. Financially in need and not a recipient of any other scholarship;
3. Willing to help develop and serve his/her community after graduation;
4. Must have good grades in English, Mathematics, Physics, Chemistry, and Biology; and
5. First Year Colleges for SY 2009-2010. Please note, only the following fields of study are covered by the IDB Scholarship
Programme:

Medicine Proper, Dentistry Proper**, Pharmacy, Medical Technology, Nursing, Physical Therapy, Nutrition, Food
Technology, Veterinary Medicine, Agriculture (including Forestry and Fisheries), and Engineering (including
Architecture, Aeronautical Engineering and Computer Science)

** Must have completed Pre-Dentistry. Second Coursers need not apply.

11. REQUIREMENTS (TO BE SUBMITTED IN TWO SETS AND CERTIFIED TRUE COPY ):
1. Completely filled-up IDB Scholarship Programme Forms;
2. Original Certificate of Enrollment for first year (1st semester) signed by the Registrar.
3. Certified true copy of Forms 137 & 138 (Permanent Record and Report Card), respectively;
4. Certified true copy of National Secondary Achievement Test (NSAT) resutl;
5. Certified true copy of NSO issued Birth Certificate or if not available certified by the local registrar or Joint Affidavit of Birth;
6. Certified true copy of Income Tax Return of Parents or Parents’ Affidavit of Income ( MUST indicate TIN);
7. Certification from an Imam or any recognized Muslim Organization that the applicant is a practicing Muslim
(not from OMA);
8. Certificate of good health from the doctor or a hospital;
9. Two (2) passport size photographs, and;
10. One (1) self-addressed stamped envelope marked speed mail or a regular prepaid LBC envelope with tracking number.

Note: 1. INCOMPLETE PAPERS WILL NOT BE PROCESSED.

2. NO PROCESSING FEE WILL BE COLLECTED.

Application forms are FREE and available at the offices of:

MS. MARILOU RABE-GUERRA, General Coordinator or HJA. MAHANGSI S. UNDAIN / MS. NURAYA S. LACKIAN, and
MR. MOHALIDIN D. ALI Secretariat, IDB Scholarship Programme in the Philippines, Manila Liaison Office – Autonomous
Region in Muslim Mindanao, Unit 502 RCI Building, 105 Rada Street, Legaspi Village, Makati City 1229
Tel. No. (632) 814-06-12 / Telefax No. (632) 814-06-13/ Cp No. 0906-8238543 Email mlo2_idb@yahoo.com.ph

HADJA JULIETA L. LANGOGAN – Chief, Records Division, Office of the Regional Governor
Autonomous Region in Muslim Mindanao, ORG Complex, Cotabato City 9600
Tel. No. (064) 421-64-95

ATTY. ABDULRAHMAN R. T. LINZAG, AL-HAJ. - IDB Educational Trust Foundation, Inc.

Suite 400 PUBC Building, Escolta, P. O. Box-3669, Manila
Tel. No. (02) 245-84-56 Fax No. (02) 241-51-42

PROF. MUHAMMAD ABDULNAZEIR N. MATLI, Ph.D. - Senior Honorary Counselor, IDB Scholarship Programme
UP Institute of Islamic Studies, UP Diliman, Quezon City
Tel. No (02) 929-8286 Email muhammadabdulnazeirmatli@yahoo.com

ENGR. PAQUITO ANDRES TALBIN - Honorary Student Counselor, IDB Scholarship Programme
Adelfa Street, Don Luis Village, Mati City, Davao Oriental 8200
Telefax No. (087) 811-0347 / Mobile No. 0917-3334915 Email pakitz@yahoo.com

Application forms and required documents must be received on or before Monday, 23 June 2009. Applicants may hand carry or mail the
requirements to:

IDB Scholarship Programme in the Philippines

Manila Liaison Office-Autonomous Region in Muslim Mindanao
Unit 502 RCI Building, 105 Rada Street, Legaspi Village Makati City 1229

Note: If someone asks payment or fee for this application, please report immediately to ARMM-Manila Liaison Office. Shukran!

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