Iskolar ni AteCong Rach Arenas

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Google Forms <forms-receipts-noreply@google.com> Fri, Apr 14, 2023 at 8:09 PM

To: delacruzmarksamuel668@gmail.com

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Iskolar ni AteCong Rach Arenas

DSWD's Educational Assistance, Third District of Pangasinan

Email *

delacruzmarksamuel668@gmail.com

PERSONAL INFORMATION

Last Name *

Dela Cruz

First Name *

Mark Samuel
Middle Name *

Halog

Barangay *
Indicate House/ Blk/ Lot number

119A

Municipality/ City *

Bayambang

Calasiao

Malasiqui

Mapandan

San Carlos City

Sta. Barbara

Date of Birth *

MM DD YYYY

03 / 02 / 2004

Age *

19

Sex *

Male
 Female

Prefer not to say

Father's Name *

manuel

Mother's Name *

susan

ACADEMIC INFORMATION

Level of Education *

College

Not Applicable

School/ University *
Do not abbreviate. Indicate what campus.

PSU-SC

Course *

BSIT

Year Level *
Indicate your current Year

Fourth/ Fifth Year College (Graduating)

 Third Year College

Second Year College

First Year College

Not Applicable

Government Scholarship *
Have you been a beneficiary of any governmental scholarship? Answer Yes or No. If Yes, kindly specify.

no

Are you enrolled under the Special Education (SPED) Program? *

Answer Yes or No. If Yes, kindly specify.

no

General Weighted Average (GWA) *

Indicate your last GWA.

93

Academic Honors
Indicate any academic honors if applicable. 

With honors

ADDITIONAL INFORMATION

Please provide the following information so we can serve you better. 

Mobile number *
09463969810

Personal Facebook Link

Example: https://www.facebook.com/RachelBabyArenas

https://www.facebook.com/marksamuel.delacruz.3?mibextid=ZbWKwL

SURVEY

Have you received any of the following assistance/ services from Congresswoman Arenas?  *
Multiple answers allowed

AICS

TUPAD

Educational Assistance

Medical Assistance

Medicine Assistance

Food Assistance

Transportation Assistance

Sustainable Livelihood Program (SLP)

TESDA Training

Burial Assistance

✓ Not Applicable

Have you followed Rachel Arenas' FB Page? *

@RachelBabyArenas

Yes
 No

AteCong Rach Arenas' Official Facebook Page

Follow and Like us! Rachel Arenas Facebook Page *

✓ Done

Not yet

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