Republic of the Philippines

Province of Bulacan
City of San Jose del Monte
OFFICE OF THE SANGGUNIANG KABATAAN
EDUCATIONAL ASSISTANCE PROGRAM
APPLICATION FORM
(Please write your name in full and in CAPITAL letters)

PERSONAL INFORMATION
Last Name: age:

First Name: Gender:

2x2 PICTURE
Middle Name:

Birth Date:
month date year

Email address: Contact No. Voter's Precinct NO.

Religion: Year of Residency:

Home Address:

EDUCATION INFORMATION
● School: Academic Year:
Year and Course: Semester:
School Address: GWA:

● Organization Membership:
Position and Date of Membership:

(to be filled out by SK Secretary)

SUBMITTED REQUIREMENTS:

Letter of Intent: Barangay I.D.: Application Status:

COR/COE: Brgy. Indigency:
Grades: School I.D.:

DECLARATION:
I hereby declare that the information supplied in this application and the documents submitted
are correct and complete to the best of my knowledge. I understand that every incorrect
information relating to my application may result to cancellation of my SKEAP application. I
hereunder sign in affirmation to the above and to the rules and regulations of the program which
I have read, understood and agreed.

Date: Scholar's Signature

Over Printed Name

Approved by:

HON. ELLA MARIE R. ROBES

SK CHAIRPERSON