UnderGrad Tuition Fee Discount

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TUITION FEE DISCOUNT FOR STUDENTS


APPLICATION FORM 1X1 PICTURE

A.Y. 2021- 2022 ✓ 1st Semester ◻ 2nd Semester

PERSONAL INFORMATION

Last Name: MARCOS First Name: JOMAR Middle Name: GASCON Course & Year: Bachelor of Culture and Arts
Education (BCAED 4)
Address: Camanang Roadside Urdaneta City, Pangasinan
Birth date: October 28 1999 Sex: Male Religion: Male
Contact Number: 09512719151
Name of Parents/ Guardian: Ferdinand O. Marcos
Employer: NONE Years in Service: NONE
Their Address: Camanang Roadside Urdaneta City, Pangasinan

Documents Submitted: ✓Registration Form ✓ Certification ✓Brgy. clearance


✓Birth Certificate ✓Grades ◻Others: ___________________
DISCOUNT APPLIED FOR: Check the type of scholarship you are applying for:
✓ Service Scholarships ◻ UCU-SP Educational Grant ◻ Editorial Board
⚪ Student Assistant ◻ Brgy. Official’s Beneficiary ⚪ SGO
⚪ Music Ensemble ◻ Alternative Learning System ⚪ The University Scribe
⚪ PCCA ◻ Loyalty Benefit ◻ Alumni Association
✓Athletic ___ No. of Students Enrolled ◻ PNP/BFP Beneficiaries
⚪Drum & Bugle Corps. ◻ PWD Benefit ◻ UCU-AFP Educational Benefit Program
◻ City Gov’t Employee’s son/daughter ◻ Sangguniang Kabataan
___ No. of Years in Service ⚪ SK Chairman ◻ UCU Employee/Employee’s son/daughter
⚪ SK Kagawad ___ No. of
Years in Service

Checked: Verified by:

CINDY E. BARROGA, MBA NHORLY U. DOMENDEN


Overall Scholarship Coordinator Director, Center for Student Leadership and
Development

Recommending Approval: Approved by:

ELISA C. CRISTOBAL, Ph.D. ATTY. DAR A. DIGA


Vice President for Administration Acting University President

DISCOUNT GRANTED: ___________


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TUITION FEE DISCOUNT FOR STUDENTS


CLAIM STUB

1st Semester A.Y. 2021-2022

Name: Jomar Gascon Marcos Course & Year: Bachelor of Culture and Arts Education (BCAED 4)
Address: Camanang Roadside Urdaneta City, Pangasinan Birth date: October, 28 1999
Contact Number: 09512719151

TYPE OF SCHOLARSHIP:________________________________________________
DISCOUNT GRANTED:______________

Date Claimed:___________________ Received By:

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