Bic ol U n iv ers it y Legazpi City, Philippines

Application for Scholarship/ Financial Grant Acknowledgement

Scholarship/ Financial Grant being applied for: CHED TD
Please CHECKInternalExternalGovernment Grant 1st Semester, SY: 2019-2020
✓
PLEASE TAKE NOTE CAREFULLY
1. Please fill up this form LEGIBLY.
2. ALL sections must be completed.
3. Applications received after the deadline WILL NOT be considered.
4. Please attach all ORIGINAL COPY/PHOTO COPY of requirements.
5. Incomplete applications WILL NOT be acted upon favorably by the
Office.
6. Applications must be filed in person.

PERSONAL INFORMATION
Last Name First Name Middle Name Gender
HERRERA JESSA MAE MIRABONA
Male ✓ Female

Date of Birth Civil Status Cellular Phone Number Email Address

04/18/2000 SINGLE 09471923383 jessamaemirabona.herrera@bicol-u.edu.ph

CURRENT STATUS
College/ Campus Degree/ Course/Major Year Level No. of Unit s Enrolled Student Status
COLLEGE OF EDUCATION ✓ Regular
BACHELOR OF SECONDARY
nd
2 year 30
EDUCATION MAJOR IN SCIENCE Irregular

High School Graduated from Date Graduated

If FRESHMAN BUCET Result High School General Average

FAMILY BACKGROUND
Father’s Name CRIZALDE N. HERRERA Occupation TAILORING
Mother’s Name EMILYN M. HERRERA Occupation HOUSEWIFE
Annual Family Income PHP 100,000 Number of Siblings in the Family 6
House Number Street Barangay
120 PUROK 5 CALABIDONGAN
Home Address Municipality Province Zip Code
CAMALIG ALBAY 4502
House Number Street Barangay
If boarding or staying with
the Relatives Municipality Province Tel/Cellphone Number

AGREEMENT
I HEREBY CERTIFY that all information indicated in this form and on the documents attached in this application for scholarship/ financial grant/
tuition fee discount are true and correct and that any concealment or misrepresentation of facts therein found will adversely affect my application.
Signature over Printed Name Date
APPLICANT JESSA MAE M. HERRERA 09/27/2020
Signature over Printed Name Date
PARENTS/ GUARDIAN
If the applicant is below 18 years old

NOTICE OF ACKNOWLEDGEMENT
Please produce three (3) photocopies of this notice
STUDENT’s COPY
1 copy for the Registrar, 1 copy for the Student Affairs Coordinator, and 1 copy for the Bookkeeper
Name JESSA MAE M. HERRERA
College/ Campus COLLEGE OF EDUCATION
Course and Year Level 2nd year College/ Campus

Scholarship/ Financial Grant CHED TD For Billing

being applied for For Tuition Fee Discount with the percentage of %
Internal Full Tuition & Other Assessed Fees
External Full Tuition Fee Discount
✓ Government Grant or Financial Assistance Full Tuition Fee Discount with Matriculation
✓ For Acknowledgement only
C E R T I F I C A TIO N
For the University Scholarship and Date
This is to certify that all requirements have been complied with in
accordance to BOR Resolution No.40 s 2000 that “only applications
Financial Grants-in-Aid Officer 1st semester
for scholarship or enrolment with privilege with complete
requirements shall be acted upon favorably by the BU OSS”. S.Y. 20 19 -2020

Office of the Student Services

Scholarship and Financial Grants-in-Aid Section

BU-F-OSS-36

Revision No.: 2 Date of Effectivity: May 18, 2015

For Renewal STUDENT PERFORMANCE
(from the previous semester) (put N/A if you don’t have any exemplary performance(s) achieved)
Students’ Conference(s), Assembly(ies), Convention(s), & other Activities attended
General Weighted
Event Date & Venue Sponsor Average earned
Title
Competitive
Sponsor
Award re-
ceived Date

Where

Contest(s)/ Competition(s) participated When

Event Date & Venue Awards Received Program(s) accomplished

Work on a
Community
Extension
Supervising Faculty

Others
(please specify)

PLEASE DONT WRITE BELOW RESERVED FOR THE OSS STAFF ONLY
The applicant has the following required documents to support his/ her application for scholarship/ financial grant/ tuition fee discount:

ITR of Parents/Certificate of tax exemption

For FRESHMAN/ NEW APPLICANTS Certificate of Registration/Pre-Assessment Form
Birth Certificate Certificate of Grades (previous semester)
BUCET Result Certification from BU HRMO
High School Report Card Certification from the BUUFA/ BUANTS
Certificate of Good Moral Character Certification/Recommendation from Dean
Certification from the Adviser
Certification from the BUIPESR (ATHLETE)
Requirements: Performing Arts Contract
Certification from the Mayor/ DILG as Certification from Benefactor
incumbent official and legitimate dependent Contract of Scholarship
Affidavit that the applicant is NOT Others:
enjoying any other scholarship/grant(s)
CERTIFICATION For the University Scholarship and Percentage Amount Date
This is to certify that all requirements have been complied with in Financial Grants-in-Aid Officer Discounted semester
accordance to BOR Resolution No.40 s 2000 that “only applications for
scholarship or enrolment with privilege with complete requirements S.Y. 20 -20
shall be acted upon favorably by the BU OSS”.

BU-F-OSS-36

Revision No.: 2 Date of Effectivity: May 18, 2015

BICOL UNIVERSITY
ISO 9001:2008
Certificate No. 100 05 1782
 Bic ol U n iv ers it y Legazpi City, Philippines

Application for Scholarship/ Financial Grant Acknowledgement

Scholarship/ Financial Grant being applied for: CHED TD
Please CHECKInternalExternalGovernment Grant 2nd Semester, SY: 2019-2020
✓

PLEASE TAKE NOTE CAREFULLY

1. Please fill up this form LEGIBLY.
2. ALL sections must be completed.
3. Applications received after the deadline WILL NOT be considered.
4. Please attach all ORIGINAL COPY/PHOTO COPY of requirements.
5. Incomplete applications WILL NOT be acted upon favorably by the
Office.
6. Applications must be filed in person.

PERSONAL INFORMATION
Last Name First Name Middle Name Gender
HERRERA JESSA MAE MIRABONA
Male ✓ Female

Date of Birth Civil Status Cellular Phone Number Email Address

04/18/2000 SINGLE 09471923383 jessamaemirabona.herrera@bicol-u.edu.ph

CURRENT STATUS
College/ Campus Degree/ Course/Major Year Level No. of Unit s Enrolled Student Status
COLLEGE OF EDUCATION ✓ Regular
BACHELOR OF SECONDARY
nd
2 year 30
EDUCATION MAJOR IN SCIENCE Irregular

High School Graduated from Date Graduated

If FRESHMAN BUCET Result High School General Average

FAMILY BACKGROUND
Father’s Name CRIZALDE N. HERRERA Occupation TAILORING
Mother’s Name EMILYN M. HERRERA Occupation HOUSEWIFE
Annual Family Income PHP 100,000 Number of Siblings in the Family 6
House Number Street Barangay
120 PUROK 5 CALABIDONGAN
Home Address Municipality Province Zip Code
CAMALIG ALBAY 4502
House Number Street Barangay
If boarding or staying with
the Relatives Municipality Province Tel/Cellphone Number

AGREEMENT
I HEREBY CERTIFY that all information indicated in this form and on the documents attached in this application for scholarship/ financial grant/
tuition fee discount are true and correct and that any concealment or misrepresentation of facts therein found will adversely affect my application.
Signature over Printed Name Date
APPLICANT JESSA MAE M. HERRERA 09/27/2020
Signature over Printed Name Date
PARENTS/ GUARDIAN
If the applicant is below 18 years old

NOTICE OF ACKNOWLEDGEMENT
Please produce three (3) photocopies of this notice
STUDENT’s COPY
1 copy for the Registrar, 1 copy for the Student Affairs Coordinator, and 1 copy for the Bookkeeper
Name JESSA MAE M. HERRERA
College/ Campus COLLEGE OF EDUCATION
Course and Year Level 2nd year
College/ Campus
Scholarship/ Financial Grant CHED TD For Billing
being applied for For Tuition Fee Discount with the percentage of %
Internal Full Tuition & Other Assessed Fees
External Full Tuition Fee Discount
✓ Government Grant or Financial Assistance Full Tuition Fee Discount with Matriculation
✓ For Acknowledgement only
C E R T I F I C A TIO N
For the University Scholarship and Date
This is to certify that all requirements have been complied with in
accordance to BOR Resolution No.40 s 2000 that “only applications
Financial Grants-in-Aid Officer 2nd semester
for scholarship or enrolment with privilege with complete
requirements shall be acted upon favorably by the BU OSS”. S.Y. 20 19 -2020

Office of the Student Services

Scholarship and Financial Grants-in-Aid Section

BU-F-OSS-36 Revision No.: 2 Date of Effectivity: May 18, 2015

For Renewal STUDENT PERFORMANCE
(from the previous semester) (put N/A if you don’t have any exemplary performance(s) achieved)
Students’ Conference(s), Assembly(ies), Convention(s), & other Activities attended
General Weighted
Event Date & Venue Sponsor Average earned
Title
Office of the Student Services
Competitive
Sponsor
Award re-Grants-in Aid Section
Scholarship and Financial
ceived Date

Where

Contest(s)/ Competition(s) participated When

Event Date & Venue Awards Received Program(s) accomplished

Work on a
Community
Extension
Supervising Faculty

Others
(please specify)

PLEASE DONT WRITE BELOW RESERVED FOR THE OSS STAFF ONLY
The applicant has the following required documents to support his/ her application for scholarship/ financial grant/ tuition fee discount:

ITR of Parents/Certificate of tax exemption

For FRESHMAN/ NEW APPLICANTS Certificate of Registration/Pre-Assessment Form
Birth Certificate Certificate of Grades (previous semester)
BUCET Result Certification from BU HRMO
High School Report Card Certification from the BUUFA/ BUANTS
Certificate of Good Moral Character Certification/Recommendation from Dean
Certification from the Adviser
Certification from the BUIPESR (ATHLETE)
Requirements: Performing Arts Contract
Certification from the Mayor/ DILG as Certification from Benefactor
incumbent official and legitimate dependent Contract of Scholarship
Affidavit that the applicant is NOT Others:
enjoying any other scholarship/grant(s)
CERTIFICATION For the University Scholarship and Percentage Amount Date
This is to certify that all requirements have been complied with in Financial Grants-in-Aid Officer Discounted semester
accordance to BOR Resolution No.40 s 2000 that “only applications for
scholarship or enrolment with privilege with complete requirements S.Y. 20 -20
shall be acted upon favorably by the BU OSS”.

Office of the Student Services

Scholarship and Financial Grants-in Aid Section

BU-F-OSS-36 Revision No.: 2 Date of Effectivity: May 18, 2015

BICOL UNIVERSITY
ISO 9001:2008
Certificate No. 100 05 1782

Republic of the Philippines CERTIFICATEOFREGITRATION Registration No:

Bicol University
(Main Campus) 20201078758
 Student No.: 2018-CE-100106 College: College of Education School Year: 2020-2021 1st Semester
Name: HERRERA, JESSA MAE MIRABONA Program:Bachelor of Secondary Education Major in Science SY 2018-2019
Gender: Female Major: Curriculum: BSED SCIENCE 2018-2019
Age: 20 Year Level: Third Year Scholarship: FREE EDUCATION

SCHEDULE
Code Subject Unit Class Days Time Room Faculty
Credit Lec Lab

GEC 19 Life And Works Of Rizal 3.0 3.0 0.0 BUCE BSED MTh 07:30 AM-09:00 AM BUCE-CSSP CE PROF 7,
SCIENCE 3-A

SCI ED 16 The Teaching Of Science (Teaching In The 3.0 3.0 0.0 BUCE BSED TF 07:30 AM-09:00 AM BUCE-CBA-02-2 MIÑA, L.-
SCIENCE 3-A 01-TH2A
Specialized Field)
SCI ED 12 Cell And Molecular Biology 4.0 3.0 1.0 BUCE BSED MTh 09:00 AM-12:00 PM BUCE-01-CB-20 MAYOR, J.
SCIENCE 3-A 6
SCI ED 14 Environmental Science 3.0 3.0 0.0 BUCE BSED TF 09:00 AM-10:30 AM BUCE-CBA-02-2 PROTACIO, G.-
SCIENCE 3-A 01-TH2A
SCI ED 15 Biochemistry 3.0 3.0 0.0 BUCE BSED TF 02:30 PM-04:00 PM BUCE-01-CB-20 RODRIGUEZ, M.-
SCIENCE 3-A 7
SCI ED 13 Modern Physics 3.0 3.0 0.0 BUCE BSED MTh 01:00 PM-02:30 PM BUCE-01-CB-20 ARROCO, S.
SCIENCE 3-A 6
SCI ED 20 Research In Teaching 1 3.0 3.0 0.0 BUCE BSED MTh 02:30 PM-04:00 PM BUCE-01-CB-20 ARROCO, S.
SCIENCE 3-A 6
Educ 9' Facilitating Learner-Centered Teaching 3.0 3.0 0.0 BUCE BSED TF 10:30 AM-12:00 PM BUCE-CBA-02-2 ARROCO, S.
SCIENCE 3-A 01-TH2A
Educ 10' Technology For Teaching And Learning 1 3.0 3.0 0.0 BUCE BSED TF 01:00 PM-02:30 PM BUCE-01-CB-11 SATPARAM, J.-
SCIENCE 3-A 0

Totals:: Subjects: 9 Credit Units=28.00 Lecture Units=27.00 Lab Units=1.00

ASSESSED FEES -
Total Units (28.00)
Med. & Den. Fee- UG/CP/ETEEAP 20.00 Total Assessment: 6,727.00
Library Free- UG/CP/ETEEAP 50.00 Less:Financial Aid: 0.00
Athletic Fee- UG/CP/ETEEAP 40.00 Net Assessed: 6,727.00
Guidance Fee- UG/CP/ETEEAP 50.00 Total Payment: 1,200.00
Cultural Fee- UG/CP/ETEEAP 20.00 Outstanding Balance 5,527.00
SCUAA Fee- UG/CP/ETEEAP 50.00 Addt'l Previous Balance: 23,793.00
Universitarian Fee 12.00
Internet Fee- UG/CP/ETEEAP 175.00
Sci. Lab. Fee- UG/CP/ETEEAP 200.00
Res./Feas./Thesis- UG/CP/ETEEAP 1,200.00
Tuition Fee- UG/CP/ETEEAP 4,900.00
Matriculation Fee- UG/CP/ETEEAP 10.00

Official Receipt: 2238577X HERRERA, JESSA MAE MIRABONA

Payment/Validation Date: Student’s Signature
07-Aug-20

KEEP THIS CERTIFICATE. YOU WILL BE REQUIRED TO PRESENT THIS IN ALL YOUR DEALINGS WITH THE COLLEGE.
PRINTED BY: JANE SIAPNO Thu Aug 13 21:00:40 2020 Note: Invalid without the Registrar's Signature