VICENTE B.

BELLO SCHOLARSHIP PROGRAM

VBBSP FORM 1. VBBSP Application Form

1 x 1 ID Picture
Date of Application

I. Personal Profile

Name:
Course & Year: Birth Date:
College/University: Gender:
STFAP Bracket: Civil Status:
Permanent Address: Citizenship:
Present Address: Birth Place:
Father's Name: Telephone:
Occupation: Mobile No.:
Mother's Maiden Name: Email:
Occupation:
School If studying, state financial support
Attended/Attending; Living with being received(if any) or income if
II. Siblings course Age Status parents? working
(Use additional space if needed)

III. Educational Background

Awards Received (if Scholarships (state benefits and
School Attended any) amount)
Elementary:
High School:

IV. Are you currently enjoying any scholarship? Yes _________ No

Name of Scholarship Grant Nature of Scholarship Grant Benefits Received

For Interviewer (Do not fill up)

V. Financial Status Amount
(Submit latest Income Tax Return, Contract, Certificate of Employment,
Annual Gross Family Income Appointment Paper and/or Certificate of Indigency)
Other Sources of Financial
Support Other forms of non-cash support received

Support from Relatives

Others

VI. Expenses
Monthly Household Expenses Student Expenses
Food (includes your own if
staying with parents) Food (if in a dorm or apartment)
House Rent Dorm Rent (if applicable)
Electricity* Allowance
Water* Others
Education (allowance)
Others
Total Total
(Include utility bills for last three months)

VII. Description of House*

1. Ownership _____ Owned _____ Rented 2. Floor Area _____ sq.m
3. No. of bedrooms _____ 4. No. of toilets _______ 5. No. of bathrooms _______
6. Appliances (no.) _____ TV _____ Refrigerator _____ Computer
Others (please specify)_________________________________________________________
7. Description of house (materials used)

8. Estimated market value Pesos

*subject to verification by VBBSP

This is to certify that all information included in this document are true. In the event that the VBBSP or my University
discovers that false information has been submitted or relevant information has been withheld, the VBBSP reserves
the right to reject my application and to make the necessary course of action.

Name and signature of applicant Name and signature of parents / guardian

Certified Correct:
Name and signature of
University Scholarship Officer