City University of Pasay

(Pamantasan ng Lungsod ng Pasay)

118 Pasadeña St. F.B. Harrison, Pasay City 2x2 Picture

PASAY CITY GOVERNMENT STUDENT FINANCIAL ASSISTANCE

_______ Semester, School Year 20 _____ - 20 _______

PERSONAL INFORMATION: (Please write legibly)

Name of Applicant: ________________________________________________________________________

Surname First Name M.I.

Home Address: ____________________________________________________________________________

No./Blk./Lot Street Barangay No. Zone No.

___________________________________________________________________________
District City Zip Code

Birthday: ________________________ Birthplace: _________________________ Gender:______________

Course: ________________________________________ Year level: ______________ Section: ___________
Number of units enrolled: ____________ Mobile Number: _______________________________________
Email Address: _______________________________________________________

PARENT / GUARDIAN INFORMATION:

Name of Parent/Guardian: _________________________________________________________________

Home Address: __________________________________________________________________________

Mobile Number: _____________________________________

REQUIREMENTS TO COMPLY:

________ ORIGINAL BARANGAY CERTIFICATION indicating that the applicant and his/her parents/guardian are bonafide
residents of the city.
_______ Photocopy of parents’.guardians’ Voter’s Certificate.
_______ Photocopy of applicants’ Voter’s Certificate.
______ Certification of Good Moral Character issued by the CUP Guidance Counselor.

____________________________________
Signature of the Applicant
Date submitted: ______________________

EVALUATED/ENDORSED BY: CERTIFIED ENROLLED:

__________________________ ___________ Prof. CLEOFE T. CASTOR _______________

COLLEGE DEAN Date University Registrar Date

PROCESSED/ENCODED BY: Applicant is qualified for:

Prof. Melvin M. Crisostomo GRANT-IN-AID

Dean, Office of the Student Affairs