2x2 Colored Photo

Complete ALL sections of this application. If not applicable, put “N/A”.

Print your answers clearly and accurately.
Appearance and completeness will be considered during the evaluation.
Attach your most current 2x2 colored photo on the upper right corner of this page.

SCHOLARSHIP APPLICATION FORM

PERSONAL INFORMATION
Name (First, Middle, Last)

Present Address

Postal Address (If different from current address)

Contact Numbers: (area code - landline, mobile) E-mail

Date of Birth (yyyy/mm/dd) Present Age

Name of High School and Address GRLA Batch (Year) Final GWA (Grade 12)

Are you part of any other scholarship program? If yes, please list and describe, including the amount
and benefits or privileges included.

Where do you intend to study in college? What course are you going to take?

FAMILY BACKGROUND
Position & Company /
Name Age Relationship
Course/Level & School

GRF LEAD Fund Scholarship Application | 1 of 3

AWARDS List down the five (5) most significant awards you received from high school starting from the most
recent.

Name of Award Award-Giving Level

Award Description Date Awarded (National, Regional,
(Rank, Name of Award) Body Division, District, School)

EXTRACURRICULAR ACTIVITIES List down the five (5) most significant leadership positions and
community involvements you performed from high school starting from the most recent.

Position / Organization / Significant Level

Inclusive Dates (National, Regional,
Activities Description Contribution Division, District, School)

GRF LEAD Fund Scholarship Application | 2 of 3

Write an essay of 300 words describing your long-term goals, why you should be considered for
the Gerry Roxas Foundation Scholarship program and how the receipt of this scholarship will
assist you in achieving those goals.

My signature below certifies: All statements and information submitted on this application
are true and correct.
Name and Signature of Applicant Date

GRF LEAD Fund Scholarship Application | 3 of 3



GERRY ROXAS LEADERSHIP AWARD

What is the Gerry Roxas Leadership Award Program?

Over the past 60 years, more than 44,000 Filipino student-leaders were recognized as Gerry
Roxas Leadership Awardees (GRLA) by the Gerry Roxas Foundation. The award, consisting of
a gold medallion and certificate, is now given to outstanding senior high school students, grade
12, from public and private institutions who have shown exemplary leadership and dynamic spirit
in both academics and extra-curricular activities.

The award hopes to serve as an inspiration to the youth to shape and live their visions for their
community and the country by exemplifying the core values of integrity, service and excellence
as espoused by its founder, Senator Gerry Roxas.

LEADERSHIP ENDOWMENT AND DEVELOPMENT (LEAD) FUND

What is the Gerry Roxas Leadership Endowment and Development Fund (LEAD Fund)?

The program aims to harness the potentials of Gerry Roxas Leadership Awardees (GRLAs) by
providing scholarship for college education and opportunities for leadership immersion through
the Foundation’s Leadership Program. The vision is to nurture the growth of emerging Gerry
Roxas Awardees who will in the future use their leadership skills and abilities to transform
communities and lead the Filipinos in nation-building.

Around 2,000 outstanding grade 12 students are selected by partner public and private high
schools to receive the Gerry Roxas Leadership Awards yearly. On the occasion of the 61st
anniversary of the Gerry Roxas Foundation, the Leadership Endowment and Development Fund
(LEAD Fund) will be extended to a greater number of Gerry Roxas awardees who in their youth
have already been recognized as role models of integrity, service and excellence and will one day
contribute in nation-building.

SPECIFIC ELIGIBILITY CRITERIA

1. The applicant must be a legitimate Gerry Roxas Leadership Awardee (GRLA) who is graduating
or has graduated from Senior High School (Grade 12) in 2019, and an incoming freshman
planning to study in any university, college or school.

2. The applicant must be pursuing undergraduate studies in community development, education,

economics, governance, accountancy, business management, hotel and restaurant
management, science, technology, engineering and other related development fields.

3. The applicant must not have a grade lower than 80% in any subject and have a general
weighted average of more than 85% or its equivalent in Grade 12.

4. The applicant must be of good moral character, verified by a document signed by the high
school principal.


APPLICATION REQUIREMENTS

Applicant/s must submit the following documents:

1. Signed letter of intent addressed to

Judy A. Roxas, President
Gerry Roxas Foundation

2. Signed scholarship application form

Note: In the scholarship application form, kindly indicate both your junior and senior high
school, if different from the latter.

3. Certified true copy of grades of previous academic

year (Grade 12)

4. Certificate of good moral character issued by senior high school principal or guidance counselor

5. Copy of GRLA certificate signed by school principal

6. Case Study Report from DSWD for scholarship purposes, stating family background,
household income, etc.

SUBMISSION AND DEADLINE

GRLA LEAD Fund scholarship applicants must submit all

the requirements on or before June 20, 2019. Completed application forms and requirements
shall be sent as pdf file to grfscholarship@gerryroxasfoundation.org.

Please use GRF_SCHOLARSHIP_(SURNAME) as subject of the email. Alternatively,

completed printed applications may be scanned and sent to the email address stated above or
mailed to:

Gerry Roxas Foundation, Inc.

LEAD Fund - Scholarship
11/F Aurora Tower, Araneta Center, Cubao,
Quezon City 1109, Philippines

For further inquiries regarding the GRF Scholarship, you may massage/contact:

Gerry Roxas Leaders Facebook Page: https://www.facebook.com/GerryRoxasLeaders1958

LEAD Fund Scholarship Program Staff

Tel. No.: (632) 421.4006 loc. 119
Mobile. No.: 0999.994.4173
Fax. No.: (632) 913.0439
E-mail: grfscholarship@gerryroxasfoundation.org


GERRY ROXAS LEADERSHIP AWARD

What is the Gerry Roxas Leadership Award Program?

Over the past 60 years, more than 44,000 Filipino student-leaders were recognized as Gerry
Roxas Leadership Awardees (GRLA) by the Gerry Roxas Foundation. The award, consisting of
a gold medallion and certificate, is now given to outstanding senior high school students, grade
12, from public and private institutions who have shown exemplary leadership and dynamic spirit
in both academics and extra-curricular activities.

The award hopes to serve as an inspiration to the youth to shape and live their visions for their
community and the country by exemplifying the core values of integrity, service and excellence
as espoused by its founder, Senator Gerry Roxas.

LEADERSHIP ENDOWMENT AND DEVELOPMENT (LEAD) FUND

What is the Gerry Roxas Leadership Endowment and Development Fund (LEAD Fund)?

The program aims to harness the potentials of Gerry Roxas Leadership Awardees (GRLAs) by
providing scholarship for college education and opportunities for leadership immersion through
the Foundation’s Leadership Program. The vision is to nurture the growth of emerging Gerry
Roxas Awardees who will in the future use their leadership skills and abilities to transform
communities and lead the Filipinos in nation-building.

Around 2,000 outstanding grade 12 students are selected by partner public and private high
schools to receive the Gerry Roxas Leadership Awards yearly. On the occasion of the 61st
anniversary of the Gerry Roxas Foundation, the Leadership Endowment and Development Fund
(LEAD Fund) will be extended to a greater number of Gerry Roxas awardees who in their youth
have already been recognized as role models of integrity, service and excellence and will one day
contribute in nation-building.

SPECIFIC ELIGIBILITY CRITERIA

1. The applicant must be a legitimate Gerry Roxas Leadership Awardee (GRLA) who is graduating
or has graduated from Senior High School (Grade 12) in 2019, and an incoming freshman
planning to study in any university, college or school.

2. The applicant must be pursuing undergraduate studies in community development, education,

economics, governance, accountancy, business management, hotel and restaurant
management, science, technology, engineering and other related development fields.

3. The applicant must not have a grade lower than 80% in any subject and have a general
weighted average of more than 85% or its equivalent in Grade 12.

4. The applicant must be of good moral character, verified by a document signed by the high
school principal.


APPLICATION REQUIREMENTS

Applicant/s must submit the following documents:

1. Signed letter of intent addressed to

Judy A. Roxas, President
Gerry Roxas Foundation

2. Signed scholarship application form

(Editable word file can be accessed here: https://tinyurl.com/LEADafdoc)
Note: In the scholarship application form, kindly indicate both your junior and senior high
school, if different from the latter.

3. Certified true copy of grades of previous academic

year (Grade 12)

4. Certificate of good moral character issued by senior high school principal or guidance counselor

5. Copy of GRLA certificate signed by school principal

6. Case Study Report from DSWD for scholarship purposes, stating family background,
household income, etc.

SUBMISSION AND DEADLINE

GRLA LEAD Fund scholarship applicants must submit all the requirements on or before June 28,
2019 (Friday). Completed application forms and requirements shall be sent as pdf format to
grfscholarship@gerryroxasfoundation.org.

Please use GRF_SCHOLARSHIP_(SURNAME) as subject of the email. Alternatively,

completed printed applications may be scanned and sent to the email address stated above or
mailed to:
Gerry Roxas Foundation, Inc.
LEAD Fund - Scholarship
11/F Aurora Tower, Araneta Center, Cubao,
Quezon City 1109, Philippines

For further inquiries regarding the GRF Scholarship, you may massage/contact:
Gerry Roxas Leaders Facebook Page: https://www.facebook.com/GerryRoxasLeaders1958

J.R. Almonina | 0927.279.0917

GRF-LDP Program Manager

LEAD Fund Scholarship Program Staff

Tel. No.: (632) 421.4006 loc. 113 / 119 / 121
Mobile. No.: 0999.994.4173
Fax. No.: (632) 913.0439
E-mail: grfscholarship@gerryroxasfoundation.org