PAUL C.

LAUS FEDILISAN-TANULONG EDUCATIONAL TRUST

2018 SCHOLARSHIP PROGRAM APPLICATION

Read through the application to understand what information you will need in order to
complete it. Seek the information and make the contacts necessary for your application
to meet the deadline. Complete each instruction or question carefully and truthfully.

PART I -- APPLICANT’S PERSONAL AND FAMILY DETAILS

1. NAME: FIRST _____________ MIDDLE _______________ LAST _______________________

IGOROT NAME: ________________________ PLACE OF BIRTH _________________________

CONTACT PHONE #: ____________________ EMAIL _________________________

2. FATHER’S COMPLETE NAME: __________________________ PLACE OF BIRTH____________

CONTACT PHONE # ____________________ EMAIL __________________________

3. MOTHER’S COMPLETE NAME: ____________________ PLACE OF BIRTH _________________

CONTACT PHONE# _____________________ EMAIL _________________________

4. PATERNAL (FATHER’S SIDE) GRAND FATHER’S COMPLETE NAME:

_______________________________________ PLACE OF BIRTH: _______________________

5. Maternal (MOTHER’S SIDE) GRAND FATHER’S COMPLETE NAME:

________________________________________ PLACE OF BIRTH ______________________

6. PATERNAL GRAND MOTHER’S COMPLETE NAME

________________________________________ PLACE OF BIRTH ____________________

7. MATERNAL GRANDMOTHER’S COMPLETE NAME

_________________________________________ PLACE OF BIRTH ____________________

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 PAUL C. LAUS FEDILISAN-TANULONG EDUCATIONAL TRUST

DAP-AY AFFILIATION and LOCATION

8. Dap-ay of father’s family ______________________ Location

_____________________

9. Dap-ay of Mother’s Family ______________________ Location

_____________________

Please explain if there is no affiliation of either or both families.

SOURCES OF FAMILY SUPPORT as they relate to your family. Rank them 1-5

(#1 is the main source; # 5 is a minor or insignificant source)

_____ wages from daily work for others
_____ salary from a regular employment
_____ wages from work in the mines
_____ produce from rice fields and other crop fields
_____ other (please describe)
.
PART II – EDUCATIONAL INFORMATION

Names of schools attended, with GPA

1. Elementary __________________________________GPA_______
2. Grades 7 and 8 _______________________________GPA_______
3. Grades 9 and 10_______________________________GPA_______
4. High school years 11 and 12 or last two years of high
NAME of school____________________________________
OVERALL GPA 11 and 12 or the last two years’ of high school __________
CORE COURSES grades 11 & 12
5. English __________ 6. Math __________ 7. Science ________

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 PAUL C. LAUS FEDILISAN-TANULONG EDUCATIONAL TRUST

PART III TARGET COLLEGE/UNIVERSITY (for new high school graduates)

1ST Choice _____________________ Intended Major or Field __________

Address
college/univ)_________________________________________

2nd Choice ______________________ Intended Major or Field __________

Address ______________________________________________________

PART IV COLLEGE ENTRANCE EXAMS TAKEN and GRADES or SCORES

1. National College Entrance Test grade _______

2. Entrance Test of Target School grade _______

3. Other exam if taken___________________________ score/grade _____

4. Other exam if taken: __________________________ score/grade ____

5. List the awards you have received in school, church and community:

6. Briefly describe in this space three values and qualities you most admire
in a person and that you would like to embody in your life.

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 PAUL C. LAUS FEDILISAN-TANULONG EDUCATIONAL TRUST

PART V Part V is to be filled out ONLY by an applicant ALREADY IN

COLLEGE OR WHO BEGAN COLLEGE who is now wishing to avail
him/herself of the PCL F-T Scholarship Program.

Name of Applicant _______________________________________

Name of school attended or now enrolled in ______________________
Overall college GPA _________
Course or major _________________________
GPA in core courses already taken of one’s major _____________
Are you changing your major? Circle one: YES NO
Transcription of grades in all college courses taken (submit with completed
application)

PART VI GUIDANCE COUNSELOR AND FACULTY MEMBER to be contacted

by the Trust for more information about the applicant.

1. Guidance Counselor name, address and contact number

__________________________________________
2. Faculty Member name, address and contact number
___________________________________________

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 PAUL C. LAUS FEDILISAN-TANULONG EDUCATIONAL TRUST

PART VII SCHOLARSHIP STUDENT STATEMENT AND AGREEMENT

I hereby certify that all the data and information that I have furnished are
accurate and complete. I understand that any misinformation and/or withholding of
information will automatically disqualify me from receiving any financial assistance.
Furthermore, if such misinformation and/or withholding of information on my part is
discovered after I have been awarded the scholarship grant or any form of financial
assistance, I will be required to reimburse all the financial benefits plus all the legal rate
of interest prevailing at the time of reimbursement without prejudice to the filing of
charges against me.
Moreover, I authorize the Trustee to make third party verification he may deem
appropriate to check on the veracity of the information contained in this application or to
obtain any additional information in this regard.
I understand that aside from this accomplished form, I may yet have to submit
other documents to be requested by the Trustee. I also understand that should this
application be successful, it will be my duty to abide by the guidelines of the PCL
Fedilisan-Tanulong Scholarship Program, such as meeting the required cumulative grade
average as well as the other requirements.
Finally, I understand that the accomplishment and submission of this application
does not guarantee of admission to the PCL Fedilisan-Tanulong Scholarship Program.

Witnessed by:
__________________________________________________________________
Guidance Counselor/Class Advisor Date

1. ____________________________________________________________
Applicant’s Signature Date

(By signing this document, you agree to abide by all the terms and conditions
set forth in this application.)

Application Noted by:

_________________________________________________
School Principal Date

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 PAUL C. LAUS FEDILISAN-TANULONG EDUCATIONAL TRUST

VIII STATEMENT OF THE APPLICANT’S PARENT OR GUARDIAN

I hereby certify that I have read the entire questionnaire and that i
certify to the truthfulness and completeness of the information
which my son/daughter has furnished in this application together
with all the documents attached. I understand that any
misinformation and/or withholding of information will automatically
disqualify him/her from receiving financial assistance. I further
recognize that in signing this application form, i share with my
son/daughter the responsibility for the truthfulness and
completeness of the information supplied therein.

Furthermore, I authorize the Trust or any of its authorized

representatives to conduct a third party verification of the
information provided here to check on their truthfulness.
_______________________________ _____________________________
Parents’ or Guardian’s Name (Print) Signature
Date

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 PAUL C. LAUS FEDILISAN-TANULONG EDUCATIONAL TRUST

IX STUDENT ESSAY

1. On the first page: write your complete name, date, your contact
address.
2. Write a short essay of 500-800 words, introducing yourself,
describing your academic goals and aspirations, how you see your
education contributing to the development of Cordillera
communities, and the reasons why you feel you qualify for this
scholarship.
3. Attach the ESSAY to the end of your completed Application form.

THE COMPLETED SCHOLARSHIP APPLICATION FORM

WITH ALL REQUIRED SIGNATURES AND DOCUMENTS
MUST BE DELIVERED AND ACKNOWLEDGED IN WRITING BY
Alma Louise B. Bagano
Dagdag, Sagada
Mountain Province
2619 Philippines
BEFORE April 15, 2018

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