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JPL Application Form 1

This document is a scholarship application form for JPL-SHL Scholarship. It requests personal information such as name, address, contact details, education history, extracurricular activities, and financial information. It also requires a certification that the applicant has read and understood the privacy policy and provides consent for their personal data to be processed. The form must be filled out completely and accurately with NA used for not applicable fields.

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Franz De Santos
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114 views

JPL Application Form 1

This document is a scholarship application form for JPL-SHL Scholarship. It requests personal information such as name, address, contact details, education history, extracurricular activities, and financial information. It also requires a certification that the applicant has read and understood the privacy policy and provides consent for their personal data to be processed. The form must be filled out completely and accurately with NA used for not applicable fields.

Uploaded by

Franz De Santos
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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F-C-CPD-008 Rev 2 (11-28-18)

2x2

JPL-SHL SCHOLARSHIP APPLICATION FORM


Examination Date:
Courses Applied For: 1.
2.
3.
Type or print clearly. Fill out the application form completely. Place NA if Not Applicable

PERSONAL DATA
Last Name
First Name
Middle Name
Permanent
Address
Telephone No. Mobile No. E-mail Add.
Age Birthplace Sex

Citizenship Civil Status

• EDUCATION
Name of School Location Year Graduated
Senior High School

Junior High School

Elementary
Indicate academic honors/award previously received Date Received

List of Scholarships / Grants held at present or in past Sponsor/Source Date Covered

EXTRA CURRICULAR INVOLVEMENT


(List of organizations in which you hold membership or in which you were active in the past)
Name of Organization From - To Position
FINANCIAL INFORMATION
Father's Name Occupation Annual Income
Mother's Name Occupation Annual Income
Guardian's Occupation Relationship
Name
No. of Employed Sisters Brothers No. of Unemployed Sisters Brothers

Give information which might be helpful in the consideration of your application.

APPLICANT'S CERTIFICATION
By affixing my signature on this form, I hereby acknowledge and certify that I have carefully read and
understood the terms and conditions of the Date Privacy Policy of the Lyceum of the Philippines University (LPU). By
providing personal information to LPU, I am confirming that the data is true and correct. I understand that LPU
reserves the right to revise any decision made on the basis of information I provided should the information be found
to be untrue or incorrect. I likewise agree that any issue that may arise in connection with the processing of my
personal information will be settled amicably with LPU before resorting to appropriate arbitration or court proceedings
within the Philippine jurisdiction. Finally, I am providing my voluntary consent and authorization to LPU and its duly
authorized representatives to lawfully process my/my child’s data information. (If REPRESENTATIVE, signature over
printed name)

_______________________
Signature over printed name
Date: __________________

TO BE FILLED UP BY THE ADMISSIONS STAFF ONLY


Requirements Submitted Upper 10% Certification Certificate of Good Moral Character Birth Certificate
Remarks

Application Status Approved Conditional


Application Processed By Date

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