City Government of Pasig

Office of the City Mayor

Application for Pasig City Scholars
School Year 2023-2024
Private School-Endorsed (PSE)
Affiliations Type of ID ID Number GWA

APPLICANT’S PERSONAL INFORMATION

Last Name Gender Place of Birth Religion

First Name Date of Birth Age Civil Status Landline Number

Middle Name
Mobile Number Email Address

HOME ADDRESS

Unit Number House Number Street Name/ Subdivision Barangay

CURRENT SCHOOL INFORMATION

Name of School School Location School Type

Academic Grade / Level Course (for Senior High School and College only) If Graduating, (Expected Date of Graduation)

FAMILY INFORMATION

Relation Name Occupation Monthly Income

Father ₱

Mother ₱

Guardian, as ₱
applicable

Combined Monthly Income ₱

EDUCATIONAL BACKGROUND

Level Name of School Inclusive Years Honors and Awards

Elementary

Junior High

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: _____________