Province of Camarines Sur

GOV. MIGZ SCHOLARSHIP PROGRAM

Provincial Capitol Complex, Cadlan, Pili, Camarines Sur

________________________________________
Name of School/College/University
________________________________________
Address

Name of Student: _____________________________________________ Age: _______ Sex: _________

Complete Address:_________________________________________ Contact No.:__________________
Name of Parent/Guardian:___________________________________ Contact No.:__________________
Course/Strand:______________________________Year/Grade Level:________ School Year:_________

SUBJECT CODE SUBJECT DESCRIPTION UNIT AMOUNT

__________________________________ ________________________________
STUDENT SIGNATURE SIGNATURE OVER PRINTED NAME OF
SCHOOL REGISTRAR/COLLEGE DEAN

VERIFICATION SLIP

NAME:________________________________________________________________________
SCHOOL/UNIVERSITY:____________________________________________________________
COURSE & YEAR LEVEL:___________________________________________________________

Please check:
Presently enjoying other scholarship
Type:_________________________

Not enjoying any scholarship from any source.

REQUIREMENTS:
 Provincial Scholarship Form
 Verification Slip Verified/Attested by:
 Report of Grades (Previous
semester/Academic Year)
 Copy of Matriculation __________________________________________
Form/Assessment (including SIGNATURE OVER PRINTED NAME OF
misc) SCHOOL SCHOLARSHIP COORDINATOR/ADMISSION
 Biodata w/ picture
NOTE: 3 copies each
For inquiries please contact:
09193218938