Bicol University-FT 2017 Form ANNEX “A”

2017 version (NOT FOR SALE)

BICOL UNIVERSITY
Legazpi City

1 x 1 picture
BICOL UNIVERSITY – FREE TUITION 2017 (BU-FT 2017)
REGISTRATION FORM

Instruction: Read General and Documentary Requirements. Fill in all the required information. Do not leave an item blank. If item is not applicable, indicate “N/A”.
PERSONAL INFORMATION

NAME
(Last Name) Maiden Name
(First Name)
Put extension if any, i.e. Jr. III (Middle Name) (for Married Woman)
Date of Birth (mm/dd/yy) Permanent Mailing Address
Place of Birth
Sex Male Female Zip Code
Student Type Continuing (Old) For New Enrollee
Regular Irregular Name of School Last Attended
New Enrollee
School Address
Returning Student
Are you a StuFAP Beneficiary? If YES ( ) Half-Merit ( ) Partial Merit ( ) CSSGPCD ( ) Iskolar Ng Bayan ( ) Tulong-Dunong ( ) SUC/GAA
Mobile Number Are your parents a 4Ps beneficiary? If YES, please indicate the household number: __________________
E-mail Address Type of Disability (if applicable) _________________ Tribal Membership (if applicable) ___________
FAMILY BACKGROUND
Father: ( ) Living ( ) Deceased Mother: ( ) Living ( ) Deceased
Name
Address
Occupation
Educational Attainment
Total Parents Taxable No. of Siblings in the family
Income
Type Grantee Institution/Agency
Are you enjoying other educational/financial assistance? ____ Yes or ____ No If yes, please specify 1. _________ ________________________
2. _________ ________________________

I HEREBY CERTIFY that all information indicated in this form and on the documents attached in this application for free tuition 2017 program are true and correct and that
any concealment or misrepresentation of facts therein found will adversely affect my application.

________________________________________________ ________________________________
(Signature over Printed Name of Applicant) Date Accomplished

Note: Fully accomplished form to be submitted to your Respective College Registrar

DO NOT FILL-OUT THIS PORTION (FOR OSAS USE ONLY)
Belongs to: (any of the following groups)
dependent of solo parent
StuFAP Grantee
4Ps Member
persons with disabilities/
indigenous and ethnic peoples
Evaluated by:
Documents Attached:
Certificate of Registration ( )
Income Qualification: ( ) 4Ps Panunumpa (certified true copy)
( ) Indigent but not 4Ps: BIR Affidavit of Tax Exemption and
please specify type of disability ______________ Certificate of Indigency from the Barangay
please specify membership __________________ ( ) Income Earner: Latest ITR Php. __________________
Authenticated University ID ( )
Processed by:

______________________________
Department Chair
GENERAL QUALIFICATION REQUIREMENTS per Section 5 of the CHED/DBM Joint Circular No.
2017-1 of April 20, 2017
 Academically-able students
 Students who are beneficiaries of nationally-funded StuFAPs, provided they meet the
admission and retention policies of the institution.
a. The tuition fees of these students shall be charged to the relevant allocation of the said
StuFAPs, provided that the total annual benefit amount of these StuFAPs are more than
Php 15, 000.
b. The tuition fees of students receiving StuFAPs with total annual benefit amounts of equal
to or lower that Php 15,000 shall be charged to the Free Tuition 2017 allocation of the SUC
and they shall continue to receive their regular StuFAPs in addition to this tuition subsidy.
_______________________________
University Scholarship and Financial Grants-in-Aid Officer
7. Graduating students with one academic year remaining, regardless of household per
capita income;
8. Non-graduating students who belong to a household that is or was a beneficiary of 4Ps;
9. Non-graduating students who were never part of a household that is or was a
beneficiary of 4Ps but still included in the Listahanan 2.0, ranked according to their
estimated per capita household income; and
10. Non-graduating students ranked according to their per capita household income based
on submitted documentation(s) for proof of income.
DOCUMENTARY REQUIREMENTS per Section 5.2 of the CHED/DBM Joint Circular No. 2017-1
Academic Requirements:

After all StuFAPs beneficiaries have been enrolled, students shall be grouped into (1)
continuing and (2) new enrollees and returning.
The priority are the continuing students and shall be given the Free Tuition slots in the following
order, subject to the availability of the Free Tuition funds:
1. Graduating students with one semester remaining, regardless of household per capita
income;
2. Graduating students with one academic year remaining, regardless of household per capita
income;
3. Non-graduating students who belong to a household that is or was a beneficiary of 4Ps;
4. Non-graduating students who were never part of a household that is or was a beneficiary
of 4Ps but still in the Listahanan 2.0, ranked according to their estimated per capita
household income; and
5. Non-graduating students ranked according to their per capita household income based on
submitted documentation(s) for proof of income.
If there are remaining Free Tuition funds, new enrollees and returning students shall likewise be
given the corresponding Free Tuition slots in the following order:
6. Graduating students with one semester remaining, regardless of household per capita
income;
1. The SUCs shall include in their respective registration forms, if these are not already
captured, information necessary for the assessment of the students, namely:
a. Student type (i.e., continuing, new enrollee, returning);
b. If the student is a new enrollee, information on when (term and academic year)
he/she last enrolled and in which institution;
c. Whether or not the student is a StuFAP beneficiary, and the total annual benefit
amount received by the student;
d. Whether or not the student belongs to a household that is or was a beneficiary of
4Ps; and Documentation(s) for proof of income submitted.
2. The SUCs shall advertise widely the call for the submission of student requirements for
assessment.
During the assessment period:
1. Students shall submit the required documents for the assessment, namely:
a. Forms of identification usually accepted by the SUC;
b. Completed registration forms;
c. 4Ps identification card of the household member grantee, if applicable; and
d. Documentation(s) for proof of income.