THE PHILIPPINE WOMEN’S UNIVERSITY

Taft Avenue, Manila

OFFICE OF THE SCHOLARSHIP COMMITTEE

Application Form for Scholarship

1.
Surname Given Name Middle Name

2.
Course Year (incoming, SY)

3. General Weighted Average

(Not lower than 2.50)
Submit certified true copy of previous trimester (no failing grades)

4. Membership and participation in Extra-Curricular activities, school and/or community

Inclusive dates Position held Name of organization

5. Financial Status of the Family

No. of Children
Rank in the Family
Job/Occupation of Father Salary/Month P
Business Name and Address
Job/Occupation of Mother Salary/Month P
Business Name and Address
(Attach latest income tax returns of parents)

5. Other requirements to be submitted:

6.1. Application letter prepared by the applicant stating the following:

a. his/her intention of availing the scholarship grant
b. affirming the commitment to finish the degree program; and
c. that he/she has not been a recipient of any other scholarship grant.

6.2. Certification from the Guidance Office and Office of the Student Affairs that
he/she has not been subjected for any disciplinary action.

6.2.Recommendation from the Dean/Head of Unit where applicant is enrolled.

I hereby certify that the above information is true and correct.

Signature of Applicant

Date
 AFFIDAVIT OF UNDERTAKING
STUDENT SCHOLARS

I, ________________________________________, _____ years of age, Filipino, married/single

and resident of _______________________________________________ under oath, hereby and say:

1. That I am awarded a scholarship grant/financial assistance on a

________________________________________________________.

2. That said scholarship/grant/financial assistance is effective for a period of

________________________ beginning_____________________________________

and ending on ___________________________________________________.

3. That I report immediately to the ________________________________________ on

_____________________________________________________________________.

4. That the entire costs of the scholarship/grant/financial assistance to be shouldered by

PWU is _________________________________________ (P________________).

5. That I shall maintain a grade not lower that 2.0 in all subjects.

6. That in the event that I shall not be able to complete my course within the period

stipulated in paragraph 2, I shall inform the University thru the Scholarship Committee

and the Human Resource Department and agree to complete my studies on my own

account an/or return the full amount.

7. That I shall submit a copy of my certificate and report of completion of the program I

have taken upon my return to the University.

IN WITNESS whereof I hereby affixed my signature this _________________ of

_____________________ at City of Manila, Philippines.

AFFIANT
 ACKNOWLEDGEMENT

BEFORE ME, a Notary Public for and in the City of Manila, an affiant personally appeared and

has subscribed and sworn to that the affidavit of undertaking was executed voluntarily and of his free will

and presented his residence certificate No. ____________ issued on ___________________________ in

_________________________________.

Doc. No.____________

Page No.____________

Book No.____________

Series of_____________