PHOTO

2x2 ID Picture

Scholarship Application Form

Application Period: August to September 2021

ELLIGIBILITY REQUIREMENT DOCUMENTS TO COMPLY

• Filipino Citizen • Letter of Intent

• Resident where Good Neighbors Philippines operates; • Certification of Indigency
• Incoming Junior/Senior High School Student sponsored • School registration (If the student are already enrolled);
or non-sponsored; • Certified photocopy of school report cards;
• Enroll/Enrolled in a school accredited by the Department • Photocopy of birth certificate;
of Education (DepEd) • Photocopy of Old/New School Id with 3 specimens of
• With (at least) 85% General Weighted Average (GWA); applicant’s signature;
• Good in Academic, exemplar character and deportment • 2x2 ID picture
status;
• Endorsed by the school head;
• Not be a recipient of any scholarship or financial aid from
other organization or individuals;
• Belong to indigent family;
• No relatives among GNIP Staff

PERSONAL INFORMATION
Full Name Gender

Date of Birth (MM/DD/YYYY) Place of Birth

Citizenship Contact Number Email Address

Present Address Zip Code

Permanent Address Zip Code

Type of Disability (if applicable) Indigenous People (IP Affliation - if any)

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 FAMILY INFORMATION
FATHER MOTHER
LEGAL GUARDIAN
( )Living ( )Deceased ( )Living ( )Deceased

Name

Address

Contact No.

Occupation

*Company

*Company
Address

Highest Education
Attainment
Total Parent’s
Income

Number of siblings in the family 18 years old and below:

Is your family is a beneficiary of DSWD’s Pantawid Pamilyang Pilipino Program (4P’s) (Yes/No):

Are you related or affiliated with any Good Neighbors staff or volunteers? (Yes/No)

If yes, please specify (Name/Relationship):

SCHOOL INFORMATION

School Sector Highest Attended Grade

Public Private

Name of School Last Attended School Address

School Intended to Enroll or Enrolled at

School Sector School Address

Public Private

Are you enjoying other education services assistance? Yes/No:

If yes, please specify: Program Name Agency Name

Do you pay the tuition fees? (Yes/No) Do you pay for other school fees? (Yes/No)

If yes, please include other school fees (i.e. Books, school contribution, etc.)

I hereby certify that the foregoing statements are true and correct. Any withholding of information will automatically
disqualify me from the GNIP Scholarship Program and refund the financial benefits received if such information is
discovered after acceptance of the award.

Signature over Printed Name Date

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 This part is the most important part of your application.
This is your chance to let the scholarship committee know why you feel you should
be a recipient of this scholarship from Good Neighbors International Philippines.

1. Can you briefly tell us something about yourself? Why are you applying for this scholarship and why do you deserve
to be selected as one of the scholars?

2. Can you briefly tell us your family situation?

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 3. What are your goals/dreams in the future? Moreover, what are the actions you plan to do to achieve your goals and
why?

4. Tell me about a personal achievement that makes you proud.

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 **This part will be filled out by the interviewer upon reviewing your application during the home visit.**

HOUSEHOLD INFORMATION

Address

Ownership Status Own with Title Own without Title Rent Land Rights
No. of Persons
Approx. Monthly Income

House Type/No of floor/s:

a. Room Type & # Bed Room: Multi Use Room Others (specify):
b. Wall Construction Plywood Concrete Corrugated Metal
c. Roof Construction Plywood Concrete Corrugated Metal
d. Construction Plywood Concrete Corrugated Metal

Cooking Facility Wood Stove Charcoal Stove Kerosene Gas Stove

Water Source Running water Neighbors Faucet Community Well Water Pump

Electricity Available Not Available Generator Solar Power

Sanitary Facility Latrine Communal Latrine

FAMILY INFORMATION

Child lives with Parents Guardian

Mother
Father
Yes No
Mother Why Absent?

Occupation Monthly Income

Father

Occupation

Notes

Verification Date:

Home Visited by: Approved by:

Signature over Printed Name Signature over Printed Name

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