APPLICATION FORM

OFFICE OF CONGRESSMAN BENJAMIN D. ASILO

"TULONG NI ATONG SA MGA MAG-AARAL NG TUNDO" QUALITY EDUCATION FOR ALL
PROGRAM
Fill up this form (IN PRINT) and submit to the Office of Congressman together with other
required documents
NAME: ____________________
(SURNAME)
SEX ____
AGE: _____
______________________

_______________________
(FIRST NAME)

______________ ____________
(MIDDLE NAME)
(NICKNAME)

BIRTHDAY: ___________________ BIRTH PLACE:

ADDRESS: _____________________________________________
__________

BGY: ____ TEL/CEL No:

FACEBOOK ACCOUNT: __________________________________ OTHER USER NAME: _______________

(Note: Confidentiality in using other user name will strictly be observed by this office)
PRESENTLY LIVING WITH (check one)
Relationship (if guardian/others)
__________
Parents Guardian Others
SCHOOL: __________________________________________________
YEAR LEVEL:
________________
COURSE: ___________________________ (check one)
5 year course 4 yr course 3 yr course
2 yr course
FATHERS NAME: ________________________
___________________
(SURNAME)
(MIDDLE NAME)

____________________________
(FIRST NAME)

OCCUPATION: _______________ PLACE OF WORK: ____________ AGE: _____ BDAY:

____________
MOTHERS NAME: __________________________
_____________
NAME)
(MIDDLE )

_____________________________
(SURNAME)

(FIRST

OCCUPATION: _____________ PLACE OF WORK: ____________ AGE: _____ BDAY: ___________

NAME OF BROTHER/s /SISTER/s

1.

AGE

BIRTHDAY

SCHOOL/WORK

2.
3.
4.
5.
New Applicant _________
Old Apllicant: __________ (pls. indicate kung anong year kayo nagstart as scholar)
_____________________

AGREEMENT UNDER THE PROGRAM, "TULONG NI ATONG SA MGA MAG-AARAL NG TUNDO"

1. APPLICANT AND HIS / HER PARENT / GUARDIAN MUST BE RESIDENTS OF TONDO 1
2. KNOWS HOW TO OPEN, OPERATE AND USE THE COMPUTER.
3. MUST BE FAMILIAR IN USING FACEBOOK
4. MUST VISIT OR LOG ON TO FACEBOOK (tahanangmasa_ctc@yahoo.com ,/, whizzhouse@ymail.com)
ONCE A WEEK.
5. WILLING TO RENDER COMMUNITY SERVICE IN THEIR OWN BARANGAY,
6.. WILLING TO RENDER SERVICES OUTSIDE THEIR BARANGGAY (TONDO/MANILA).
7. MUST POSSESS THE CHARACTER OF A GOOD STUDENT AND HAVE DESIRE TO FINISH STUDIES.
8. KINDHEARTED AND CARING TO PARENTS
9. HINDI PA GRANTEE O NAG-APPLY SA ANUMANG INSTITUSYON, SIMBAHAN, PAARALAN O IBA PA.,
10. IF POSSIBLE, NO BODY MARKINGS (TATTOO BOTH BOYS AND GIRLS AND NO EARINGS (BOYS)
11. Isa lang sa magkapatid ang pwedeng mag-aaply sa ating programa.

_____________________________________
PARENT / GUARDIAN SIGNATURE

_____________________________________
SIGNATURE OF APPLICANT