LICEO DE CAGAYAN UNIVERSITY

Rodolfo N. Pelaez Boulevard, Kauswagan Road,

Cagayan de Oro City

APPLICATION FOR ACADEMIC SCHOLARSHIP

Semester / Summer S.Y. 2020-2021
BASIC EDUCATION (S.Y. 2020-2021) / COLLEGE OF
INSTRUCTION: Please process this application in the sequence indicated. This form is to be accomplished
in four copies and distributed to the following: Registrar, Finance, College and Student. Write information in
BLOCK LETTERS and submit all supporting documents to facilitate approval. Thank you.
LAST NAME FIRST NAME MIDDLE NAME GENDER AGE
CAYETUNA ELNE MAE EXCHAURE FEMALE 17

Grade / Course / Year Level & Section:Years in LDCU:LAST SCHOOL ATTENDED/ADDRESS:

GRADE 11 / STEM PROIS INTERNATIONAL CHRISTIAN SCHOOL
SYSTEM. NATIONAL HIGHWAY TAGOLOAN, MISAMIS ORIENTAL, 9001 TAGOLOAN, PHILIPPINES

BASIS FOR APPLICATION:

Valedictorian/Top 1 ✔️Salutatorian/Top 2 ___ Academic Performance ____Other

I HEREBY apply for an Academic Scholarship on the basis of above qualifications. I also hereby certify
that all supporting documents submitted in connection with this application are authentic. I further bind
myself to the rules and regulations of the University and to those pertaining to scholarships.

Student’s Name/Signature: Elne Mae E. Cayetuna Date: August 29, 2020

1. REGISTRAR OFFICE
Documents Submitted:

FORM 9 (F138) School Certification Others

TOR / Most Recent Grades QPA
Documents / QPA Verified by: Date: Registrar Signature: _ Date:

2. DEAN / PRINCIPAL’S OFFICEDetails of Scholarship Recommended:

Full Partial
Recommend Approval Tuition & Other Fees only
Not Recommended Books Uniform Others

Dean/Principal Signature: Date:

3. OFFICE OF THE PRESIDENT / EXECUTIVE VICE PRESIDENT

Disapproved
APPROVED for FULL / PARTIAL ( % SCHOLARSHIP)
Include: Tuition and Other School Fees Only
Books Uniform Others

PRESIDENT / EVP Signature: Date:

THIS APPROVAL IS VALID FOR THE TERM INDICATED
ABOVE