SERVICE – SCHOLARSHIP PROGRAM

APPLICATION FOR SCHOLARSHIP SY: 20__ - 20____

GENERAL INFORMATION ABOUT THE CANDIDATE

Name ____________________________ CHID _________ Date of Birth ________________ Age___________

Email Address ________________________________________ Contact Number/s _____________________

Name of college/university___________________________________________Year level________________

Course of study __________________________________________Major _______________________________

Name of school (high school) ________________________________________Average Grade_____________

GENERAL INFORMATION ABOUT THE FAMILY

Father’s Name _______________________________ Occupation _____________________ Age____________

Mother’s Name _______________________________ Occupation _____________________ Age ___________
Other Guardian’s Name ________________________ Occupation _____________________ Age __________
Father’s Monthly Income_______________________Mother’s Monthly Income________________________
Home Address _______________________________________________________________________________
Total number of other children living in this household? ________ No. of children in school_____________

Name of Children Ag Name of School Grade/ Occupation Please

e Year and indicate if
(All living siblings Attending
currently or
only) Level Income
previously
sponsored,
and or a
former
service-
scholar
Having said the above and as the head of the family, I am requesting Unbound to register my child in the
Unbound Service – Scholarship Program for educational help.

I am in total agreement with regards to the requirements of Unbound to be a part of the scholarship
program. I also accept the Unbound Service - Scholarship that will be given, directly or indirectly, using
it to benefit his/her education.

Service-scholarship candidate Parent/Guardian of the candidate

Printed Name:________________________ Printed Name:_________________________

Signature: ___________________________ Signature: ____________________________

 SERVICE SCHOLARSHIP PROGRAM

ESTIMATED COST OF STUDY

School Year ________________

Name of Scholar: ___________________________________ CH/SSP ID:

_________Sub/Cluster:___________
Name of School:____________________________________ Public/Govt: ______Private:
_______________
Course: _____________________________ Year Level:_________ # of Years in the
SSP:________________

OTHER FAMILY
ANTICIPATED FOR SOURCE (SF, COUNTERPART
TOTAL
EXPENSES REQUEST other
Scholarship
grant)
Tuition Fees

School /Dept
Uniforms

Wash Clothes
Books

School Supplies

School Projects

Boarding House

Transportation

Others

TOTAL

Prepared by:

_______________________________________ __________________
Signature over Printed Name of Service Scholar Date

Reviewed by: Checked by: Noted by:

_________________________ _________________________ ____________

SSP Subproject Representative Finance Staff

SERVICE-SCHOLARSHIP PROGRAM

LETTER OF COMMITMENT
(SY:_____-_____)
 Between Unbound Scholarship Program Committee and the Scholarship Recipient

The Unbound service-scholarship program, represented by the Scholarship Committee, is committed to give a service-scholarship
to _________________________________CHID# __________ for the period of_________________to________________ in
accord with the study done of him/her with their parents or legal guardians. Therefore, the scholarship recipient and Unbound are
committed to the following Articles:

First: Unbound is committed to provide a scholarship equivalent to _________ US Dollars/__________ Peso per school term,
once all of the registration requirements petitioned by Unboundare met.

Second: The Unbound could suspend or cancel the scholarship support any time within the academic year for lack of academic
performance, lack of community service and other activities or conditions the project deems harmful to the overall scholarship or
sponsorship program.

Grounds for Non-eligibility:

1. Entering into a ‘romantic’ relationship
2. Earring or multiple piercings in any part of the body
3. Hair coloring
4. Tattoo marking
5. Joining fraternity/sorority group
6. Smoking, gambling, drinking or using of illegal drugs
7. Forging and falsification of documents

Third:Unbound will provides Capability Building Sessions, Peer Counseling, Life Skills, Leadership, Values enrichment and
other related formations, including faith and life, to encourage education within the society we live in and to assure that young
people have the possibility of a better future.

Fourth: The scholarshould faithfully observe his/her following duties during the scholarship period:

A. Assist the sponsored members, families and communities in various activities but not limited to Academic Tutorials, Values
Formation, Talent Development, Recreation, Care for God’s Creation, Neighborhood Play, Practical and Life Skills
Development and other Unbound activities as well as assisting in Letter Writing, Annual Photo of Unbound sponsored.
(Note: Every scholar is required to assist/serve the sub project at least 16 hours a month or 160 hours per one school term).
B. Develop an Individual Community Service Plan (ICSP) in relation to the service that will be rendered either outside or
within Unbound community with the approval from the project or subproject.
C. Actively take part in the Capability building, Team building, Values Formation sessions and regular meetings intended
solely for them, which will serve as one means of their own spiritual formation and growth.
D. Write a Thank You Letter and Card to Unbound once finishes education.
E. Write a Personal Statement to Unbound at the end of every academic year that includes the following information:
o General description of their family situation
o Description of their course of study
o Experience in school in the past semester
o Brief description of the community service performed
F. Regularly report and present report card/class cards/certificate of grades to the Sub Projectfor proper coordination and
monitoring.

G. Maintain an average grade of at least 83% or its equivalent for each current semester. An average below that required GWA
means non-renewal or automatic removal from the Scholarship Program

H. Submit liquidation two weeks aftereach scholarship grant has been withdrawn to their child account.

I. The student agrees to provide the community service hours according to the following schedule:

Assigned Area and or Group Day/s Time

Fifth:The parents or legal guardians of the scholar should attend all meetings convoked for them by Unboundand render
voluntary service in any form that will benefit the project or subproject in general.Therefore, attendance is obligatory for the
scholars’ parents as indicated.

Sixth.This commitment is voluntary and only applies to the receipt of academic scholarships. Under no circumstances will the
scholarship student be subjected to the responsibilities of a labor relationship. Therefore, no rights or obligations pertaining to a
labor relationship will be granted.

Seventh:The scholar who has not done adequate service during the final year of study, will contribute an agreed upon service
after graduation using the talents learned.

Eighth: The set disbursement of scholarship support will be once or twice unless otherwise specified by the UnboundScholarship
Committee and must be used in payment of educational scholarship and school-related activities or projects and travel expenses.
It is not meant to cover all expenses. The student and their family are expected to provide the rest of the support.

_________________________________ ___________________________

Unbound Scholarship Representative/s Name and Signature of Scholarship recipient

Date: __________________ Date: __________Subproject: ________

SERVICE SCHOLARSHIP PROGRAM

Application Interview Sheet
Name: ______________________________ Birthdate/Age: __________
Course/Year: ________________________ School: ________________
Contact Number: _____________________
Address:______________________________________________________________________
____
1. School Rating (Overall General Average of recent year) 20%
___general average of 83% and ABOVE - 20% ___ ___general average of 82% -80% - 15% _____________
 ___general average of 79% - 75 - 10% ___

2. Family Condition 35%

__ RATE 1: 35% __ RATE 2: 30% __ RATE 3: 25%
*PCI of 25,000 and below *PCI of 25,000 and below *PCI of 25,000 and below
*S- 4 and ABOVE max of 3 studying *S- 3 and BELOW max of 2 studying *S- 3 and BELOW only 1 studying
* Residency of at least a
year * Residency of at least a year * Residency of at least a year

__ RATE 4: 20% __ RATE 5: 15% __ RATE 6: 10%

*PCI of 25,000 and ABOVE *PCI of 25,000 and ABOVE *PCI of 25,000 and ABOVE
*S- 4 and ABOVE max of 3 studying *S- 3 and BELOW max of 2 studying *S- 3 and BELOW only 1 studying
* Residency of at least a
year * Residency of at least a year * Residency of at least a year

A. Family’s Source of Income __________________ Father (Total Gross Income) Php

_____
__________________ Mother X 12 (months) ________________
B. # of Family Members ⁄ ___(Number of
dependents)
Lives withFather ___ Mother ___ Others___
Name of Siblings Status Income (PCI) Php _______________
a. _______________ ____________________________
b. _______________ ____________________________
c. _______________ ____________________________
d. _______________ ____________________________
e. _______________ ____________________________ C. Years of Residency in
the area: _____
f. _______________ ____________________________
g. _______________ ____________________________
h. _______________ ____________________________
i. _______________ ____________________________
3. Student Competencies (Summative) 25%
___Interpersonal Skill - 15pts. . ___Technical/Creative Ability - 10pts.
(Verbal & Non-verbal communication, (to base on spontaneous
talent/skill showcase)
Listening, Questioning, Manners, Self-
Management,Assertiveness) Total: ____
4. Written Examination 20%
(Total scores divided by the total number of items multiplied by 20%)

Interviewed by/DATE: ____________________________

INDIVIDUAL COMMUNITY SERVICE PLAN

ICSP FORM – SY: ___-______

NAME: ___________________________________________________________________ CH/SSP

ID#: __________________SUB: ___________________
COURSE: _________________________________________________ MAJOR:
_______________________________ YEAR LEVEL: __________________

DESCRIPTION OF PLANNED COMMUNITY SERVICE PROJECT

PLANS ON THE AREA OF EDUCATION AND TRAINING:

Service or work to be contributed by Schedule of Budget

the student implementation

PLANS ON THE AREA OF FAMILY AND COMMUNITY BUILDING:

PLANS ON THE AREA OF SOCIAL SERVICES:

PLANS ON THE AREA OF ADVOCACY:

PLANS ON SPECIAL PROJECTS FOR THE COMMUNITY/OTHER INITIATIVES:

SIGNATURE OF STUDENT: _______________________________________
APPROVING STAFF: ______________________________________________

DATE: _______________________________
NAME AND SIGNATURE OF SUBPROJECT STAFF