4Ps PARTY-LIST (Pagtibayin at Palaguin ang Pangkabuhayang Pilipino Party-List)

EDUCATIONAL ASSISTANCE PROGRAM

*A PRIVATE SECTOR INITIATIVE Ctrl. No.:___________

APPLICATION FORM
Write legibly.
PERSONAL INFORMATION

LAST NAME FIRST NAME MIDDLE NAME Ext.

PERMANENT ADDRESS:

STREET BRGY TOWN PROVINCE

BIRTHPLACE: MOBILE/PHONE NO.:

BIRTHDAY: CIVIL STATUS: GENDER:

FAMILY BACKGROUND
FATHER’S FULL NAME:

ADDRESS:
/
EDUCATIONAL ATTAINMENT: MONTHLY INCOME:

MOTHER’S FULL MAIDEN NAME:

ADDRESS:

EDUCATIONAL ATTAINMENT: MONTHLY INCOME:

ACADEMIC INFORMATION
SECONDARY SCHOOL ADDRESS:

DEGREE PROGRAM/ COURSE TAKEN:

YEAR LEVEL:

PERSONAL REFERENCES:
1.
2.
3.

I hereby certify that the foregoing statements are true and correct.
Any misinformation or withholding of information will automatically
RECENT
disqualify me from the educational assistance program. 2X2
ID PICTURE
________________________________
Applicant’s Signature over Printed Name

EVALUATED / RECOMMENDED BY: APPROVED BY:

4PS PARTY-LIST COORDINATOR

Requirements:

1. 4Ps Party-List Educational Assistance Application Form

2. Certificate of Enrollment (Photocopy)
3. Transcript
6. of Records
Barangay (from previous school year)
Indigency
4. Student ID (or any government ID)
5. Barangay Clearance

Qualifications:

 Must be enrolled in the current semester.

(atleast no grades lower than 2.5)
 No failing marks from the previous semester.