BULACAN STATE UNIVERSITY

City of Malolos, Bulacan

OFFICE OF THE STUDENT FINANCIAL ASSISTANCE
AND SCHOLARSHIPS
Tel.# (044) 9197800 local 1086/ (044) 7906520
scholarship@bulsu.edu.ph

A P P L I C A T I O N F O R M
PICTURE
2x2
Scholarship Category/Specification

Semester SY 20 - 20

Student Number: Date:

PERSONAL DATA

Name: Age: Course/Yr./Sec.

(Surname) (First Name) (Middle) major:

Campus: ( ) Main Campus ( ) Satellite:

Place of Birth Citizenship

Date of Birth Civil Status

Permanent Address Contact No.

Father Occupation Monthly Income:

If retired, year of retirement If with pension, amount of pension

Mother Occupation Monthly Income:

If retired, year of retirement If with pension, Amount

If both parents are unemployed, state reasons/s

(E.g. retired, old age, health, etc. source of livelihood)
(or contributions from other sources like relatives, etc.)

If self-employed, state type of business Earnings per year P

Guardian Occupation Salary Relation

(If applicant is employed)

Occupation Salary

(If applicant is married)

Name of Husband/Wife Occupation Salary

Name of Children Age

BulSU-OP-OSFAS-01F1
Revision: 0
(For unmarried applicant only)

Names of Brother and Sister Age Civil Status If working, state income/If student, state year level

Subjects taken in the Immediate Units Grade

Preceding Semester

Total No. of units GPA

Other information:
1. Are you enjoying any scholarship or financial assistance, in the University? Yes ( ) No
( ). Outside the University? Yes ( ) No ( )

If the answer is “yes” to either or both, specify nature and amount of grant or
salary:

2. Do your parents: (a) own real properties? Yes ( ) No ( )

If yes, specify: Market Value

Others: (ex. cars, stocks, etc.) Market value:

I hereby certify that all the statements above are true and correct.

SIGNATURE OVER PRINTED NAME

Recommending Approval:

MS. JANE KRISTINE G. SUAREZ ASSOC PROF. JOSEPH ROY F. CELESTINO

Head, OSFAS Vice Chancellor for Student Affairs and Services

APPROVED:

DR. CECILIA N. GASCON

University President