City Government of Pasig

Office of the City Mayor

Application for Pasig City Scholars
School Year 2023-2024
NEW
Affiliations Type of ID ID Number GWA
Regular Applicant School ID 406889157195 91
APPLICANT’S PERSONAL INFORMATION

Last Name Gender Place of Birth Religion

SEPTUADO Male Pasig City Roman Catholic
First Name Date of Birth Age Civil Status Landline Number
JEFF EMANUEL 4/4/2007 16 Single 1
Middle Name
Mobile Number Email Address
GEPOLAN 09652704816 jeffemanuelseptuado@icloud.com

HOME ADDRESS

Unit Number House Number Street Name/ Subdivision Barangay

1-A 765 NARRA MANGGAHAN

CURRENT SCHOOL INFORMATION

Name of School School Location School Type

ARELLANO UNIVERSITY - ANDRES BONIFACIO CAMPUS PASIG CITY PRIVATE
Academic Grade / Level Course (for Senior High School and College only) If Graduating, (Expected Date of Graduation)
Senior High - Grade 11 STEM

FAMILY INFORMATION

Relation Name Occupation Monthly Income

Father N/A Separated ₱

Mother EMELYN G. SEPTUADO Self-employed ₱ 10000

Guardian, as () ₱
applicable

Combined Monthly Income ₱ 10000

EDUCATIONAL BACKGROUND

Level Name of School Inclusive Years Honors and Awards

Elementary LIGHT OF LIFE CHRISTIAN SCHOOL 2016-2018 With honor

Junior High EUSEBIO HIGH SCHOOL 2019-2023 With honor

Senior High

Tertiary

CONSENT AGREEMENT

I, ________________________________a PCS applicant / acting as legal guardian of _______________________________ who is

currently applying for admission to Pasig City Scholarship Program, am giving my consent for the PCS Office to collect and process our
personal data in relation to the purpose of admission as PCS Scholar.

ACCEPTANCE OF TERMS
We affirm that the facts herein provided are true and correct as of the date hereof. We hereby authorize the Pasig City Scholars Office and its authorized
representatives to verify the information submitted. We understand that if awarded the benefits under the PCS, any false statement, omissions, or
misrepresentation made in this application form may result in the immediate withdrawal of the scholarship grant.

________________________________ ______________________________________
Signature of Applicant over Printed Name Signature of Parent/ Guardian over Printed Name
Date Signed: _____________ Date Signed: _____________

_________________________________________________________________________________________________________________________
SUMMARY OF RATINGS
Financial [ ] Passed [ ] Failed Interview [ ] Passed [ ] Failed
Academic GWA _____________________ Values Education / (ESP) ___________________
Interviewed by ______________________ Checked/ Assessed by _____________________