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Application Form - Higher Education Support Program

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12 views

Application Form - Higher Education Support Program

na

Uploaded by

april legaspi
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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Republic of the Philippines

City of Santiago
ID picture taken within
Office of the City Mayor the last 6 months
LOCAL LITERACY COORDINATING COUNCIL OFFICE (2 X 2)
City Hall Compound, San Andres, Santiago City
Email: [email protected] facebook: KAISAKAsaEdukasyonatLiterasiya Mobile: 0997-551-7428

HIGHER EDUCATION SUPPORT PROGRAM APPLICATION FORM


Instructions: WRITE IN PRINT (UPPERCASE). MARK APPROPRIATE BOXES WITH CHECK (√)
I. PERSONAL INFORMATION
LAST NAME:
FIRST NAME:
MIDDLE NAME:
MALE
DATE OF BIRTH: PLACE OF
_____/_______/_________ AGE: SEX:
(mm/dd/yyyy) BIRTH:
FEMALE
CIVIL STATUS: SINGLE WIDOWED
SEPARATED MARRIED
HOUSE NO. BLOCK NO. SUBDIVISION
If Married, Full Name of Spouse:
RESIDENTIAL
_____________________________ ADDRESS: PUROK STREET BARANGAY

SANTIAGO CITY 3311


CITY ZIP CODE

CITIZENSHIP: PRECINT NO.:


RELIGION:
DEGREE/
MOBILE NO: COURSE:
EMAIL: (WRITE IN FULL)

FACEBOOK: YEAR LEVEL: 1st Year 2nd Year 3rd Year 4th Year 5th Year
INSTAGRAM: TWITTER: STUDENT ID:
OTHER SOCIAL MEDIA ACCOUNTS: SCHOLARSHIP STATUS: OLD NEW
TYPE OF  Academics
SCHOLARSHIP:  Non-Academics Note: Please compute General Weighted Average: (______________)
I. FAMILY BACKGROUND
FATHER MOTHER
LAST NAME: LAST NAME:
FIRST NAME: FIRST NAME:
MIDDLE NAME: MIDDLE NAME:
OCCUPATION: OCCUPATION:
AGE: Other Concern: AGE: Other Concern:

II. EDUCATIONAL BACKGROUND


INCLUSIVE
NAME OF SCHOOL YEAR YEARS
LEVEL HONORS RECEIVED
(Write in full) GRADUATED FROM TO

PRIMARY:
SECONDARY:
TERTIARY:

I certify that I have personally accomplished this form which is true, correct and complete statement pursuant to the provisions of pertinent laws, rules and
regulations of the City Government of Santiago. I agree that any misrepresentation made in this document and its attachments shall invalidate my application.

___________________________________________ ________________________
Signature over Printed Name Date

This portion is to be filled up by the Local Literacy Coordinating Council Secretariat.


NEW SCHOLARS:
Verified by: Checked by:
 Duly Accomplished Application Form with 2x2 White Background Photo.
 Photocopy of Assessment Form of the 1st Semester S.Y 2024-2025.
o Academics: Original Certificate of Grades 2nd Semester S.Y 2023-2024
(GWA of 85 and no grade lower than 80, NO INC, IP, and Dropped).
__________________ o Non-Academics: Original Certificate of Grades 2nd Semester S.Y 2023-
ENGEL KENNETH P. CULTIVO Signature over Printed Name 2024 (“Same on Academics”) & Certificate of Engagement
Signature over Printed Name (school/barangay/organization) (No INC, No IP, FA, and Dropped).
 Updated Voter’s Certificate of the Applicant and Both Parents.
(Photocopy, Current Vote 5/09/2022)
 Photocopy of Government Employee I.D of parents (for students whose
parent/is/are government employee/s).
Note: All applications are subject for assessment.
Date: Date:
Remarks: ____________________________________________________
OLD SCHOLARS:
 Duly Accomplished Application Form with 2x2 White Background Photo.
 Photocopy of Assessment Form of the 1st Semester S.Y 2024-2025.
o Academics: Original Certificate of Grades 2nd Semester S.Y 2023-
2024 (GWA of 85 and no grade lower than 80, NO INC, IP, Failed
Grades, and Dropped).
o Non-Academics: Original Certificate of Grades 2nd Semester S.Y
JANET C. FRANCIA-ORPILLA
2023-2024 (GWA lower than 85, No INC, IP, Failed Grades, and City Secretary
Dropped) PLUS Certificate of Engagement Head, LLCC and LSB Secretariat
(school/barangay/organization).

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