City Government of Pasig

Office of the City Mayor

Application for NEW Pasig City Scholars

AFFILIATIONS
___​ ​4Ps ___ PWD ID Number:
___​ ​Child of Solo Parent ___ SK Official LR Number: ​136739120162
___​ ​Out of School Learner ___ None

For SK Officials Only

Position Barangay

CURRENT SCHOOL INFORMATION

Name of School: ​SANTOLAN HIGH SCHOOL School Type:​ Public Academic Level:​ Junior High

PERSONAL INFORMATION
Source Income, ​if any​:
Name of Applicant

Last Name: ​BACANI Given Name: ​CLARISSE ANN Middle Name: ​DEL ROSARIO

Gender: ​Female Date of Birth: ​6/15/2006 Civil Status: ​Single Religion: ​Roman Catholic

Mobile Number: ​09397557783 email Address: ​clarisseannbacani1@gmail.com

HOME ADDRESS

Unit No. House Number Street Name Barangay

173 C EVANGELISTA ST., Santolan

FAMILY INFORMATION

Name Date of Birth Occupation Grossn Monthly Income

Father

Mother ANALIZA DEL ROSARIO BACANI 2/3/1981 VENDOR

Guardian, ​if any >

EDUCATIONAL BACKGROUND

Name of School Inclusive Years Honors and Awards

Elementary SANTOLAN ELEMENTARY SCHOOL 2012 to 2018

Junior High SANTOLAN HIGH SCHOOL to

Senior High to

College Program or Course

ACCEPTANCE OF TERMS
We affirm that the facts herein provided are true and correct as of the date hereof. We hereby authorize the Pasig City Scholars Office and its authorized
representatives to verify the information submitted. We understand that if awarded the benefits under the PCS, any false statement, omissions, or
misrepresentation made in this application form may result to the immediate withdrawal of the scholarship grant.

______________________________ ______________________________
Signature of Applicant Signature of Parent/ Guardian
over Printed Name over Printed Name

………………………………………………………………………………………………………………………………………………………………………………….

SUMMARY OF RATINGS
Financial [ ] Passed [ ] Failed Values Education​ ___________________ RANKING/ SCORE:​ __________
Academic Rating _____________________ Interview ​[ ] Passed [ ] Failed
Interviewed by _____________________ Checked/ Assessed by​ _______________