Control # _______

UNIVERSITY OF SANTO TOMAS

OFFICE FOR STUDENT AFFAIRS

SCHOLARSHIP ENCODING FORM

1st Term, AY 2023-2024
[ ] NEWLY ACCEPTED [ ] RENEWAL
INSTRUCTIONS:
1. Accomplish the form completely.
2. Write legibly and strictly NO ERASURES.
3. Present this form for scholarship encoding. Student
Number:

PERSONAL DATA

NAME:______________________________________ UST EMAIL ADD:_________________________________________________

SURNAME FIRST NAME MIDDLE NAME ALTERNATIVE EMAIL ADD: ________________________________________
PROGRAM ENROLLED:__________________________ FACEBOOK ACCOUNT: ____________________________________________
YEAR AND SECTION:__________TELEPHONE NUMBER:_________MOBILE NUMBER:____________

ACADEMIC PERFORMANCE REPORT (2nd/Special Term, AY 2022-2023) SCHOLAR’S EXTRA-CURRICULAR INVOLVEMENT

TOTAL ACTIVITIES
ORGANIZATION POSITION
SUBJECTS (For renewal: ATTENDED
GRADE UNITS Multiply
(Write the subject code)
Grade and
Units)

I hereby certify that all of the above-mentioned information

is true and correct.

______________________
SIGNATURE

__________________
DATE FILED
AVERAGE GRADE OF LAST TERM

SCHOLARSHIP SCHEME SCHOLARSHIP DISCOUNT

PLEASE CHECK AND INDICATE SPECIFIC FUND TO BE FILLED OUT BY THE SCHOLARSHIP-IN-CHARGE
(e.g. Valedictorian/Cum Laude/Sta. Rosa de Lima/San Juan Macias/MBFI-
Boysen/Athlete-Basketball Men/Liturgikon)
[ ] BY PERCENTAGE: [ ] BY AMOUNT:
[ ] SANTO TOMAS:______________________ ___% TUITION
[ ] SANTO DOMINGO:___________________ ___% MISCELLANEOUS Php _____________
[ ] SAN MARTIN:_______________________ ___% OTHER FEES
[ ] SAN LORENZO RUIZ:_________________ ___% OTHER CHARGES
*For San Lorenzo Ruiz, indicate assigned office/department ___% TOTAL FEES
**SCHOLARSHIP INITIALLY GRANTED: __Term, AY 20__-20__**
VERIFIED:____________ ENCODED:_______________

UST:SO30-00-FO74