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Application Form for UA&P University Grants


School Year ___________ Applicants Name _______________________________________________________________________________________ (Legal Name in Birth Certificate) Last First Middle Nickname School ________________________________________________________________________________________________
(Current/Last Attended)

Application for: (Kindly check which type of scholarship you are applying for) Merit Scholarship Financial Assistance
Applicants who might fall below the criteria for Merit Scholarship but may qualify for the financial aid grant are advised to submit their financial information together with this application form.

Application for:

Renewal (for existing UA&P Financial Assistance grantees) New

INSTRUCTIONS: 1. Parents or guardians of the student-applicant should accomplish this form correctly and completely. Kindly put NA if the information asked for is not applicable to you. Do not leave any space blank. 2. The following documents must be submitted together with this accomplished form: Letter of request from parents/guardian justifying the need for financial assistance; Clear photocopy of the most recent Income Tax Return (Proof of Income) of each parent indicating the tax withheld on compensation of the previous year; Original copy of Billing Statement (phone/water/electric bills/credit cards); Certification from current employer of annual salaries and benefits of the applicants parents and siblings who contribute to family income submitted copy must always be original; For parents or guardians who are not employed or not filing any taxes, please submit a CERTIFICATE OF NON-FILING OF TAX issued by the BIR Office. (Affidavit or certificates issued by a local barangay or municipality will NOT be considered sufficient); Recommendation form (to be filled up by a teacher or counselor who knows your academic and family background). All information shall be considered confidential. Inaccurate information given will be a cause for disapproval or cancellation of the grant.

PERSONAL INFORMATION
1. High School : __________________________________________________________ (For Existing UA&P Students) Year and Course __________________ 2. Home Address: ________________________________________________________ 3. Mobile Phone no. ____________________________ Tel No.: ____________________ 4. Email Address: _________________________ Sex ____ Birthday : _______________ 5. For provincial Applicants, where will the student live during his/her studies in UA&P? Dorm / Boarding House Own Residence in Manila With a Relative Others, please specify: ______________

6. In which other universities / foundations / agencies are you applying for a scholarship or financial assistance grant? __________________________________________________________________________________________________ __________________________________________________________________________________________________

FAMILY BACKGROUND
Father Name Birthdate Deceased (Yes/No) Permanent Home Address Zip Code Telephone Number/Fax Number Cellphone Number Email Address Highest Educational Attainment Last School Attended Occupation If self-employed, nature of work Mother

Number of Years in Business Amount of Capital Investment Annual Gross Income ( Annual commissions, fees, or allowances ) Annual Net Profit If employed, name of Company/Employer Business Address

Position Number of Years employed in the job Annual Gross Income (Salary) Annual Additional Income (Allowances, Per Diem, Bonus) If Unemployed: Company last employed When Reason(s) for being unemployed

* Please do not leave any item unanswered. 1. Name(s) of Children 2. Age 3. Civil Status 4. Grade/Year/ 5. Highest Educational Attainment 6. School 7. Still residing with the

8.

immediate family? (Yes /No) If currently enrolled, kindly indicate the amount of tuition fees and the person shouldering the payment (i.e. parents, relatives, others) Enrolled under educational plan Educational Plan Company Benefit Others (specify)

9.

10. If

currently availing of a scholarship or financial assistance from other sources, kindly indicate the type and amount. 11. If already employed, or has own business, kindly indicate the position and nature of the business.
12. Name

of company / employer. Gross Income Yes No Household School Yes No Household School Yes No Household School Yes No Household School Yes No Household School

13. Annual

14. Helping

with the expenses?

15. Indicate

other dependents living in the house. (specify) 16. Are there others (relatives/friends) helping in the expenses? 17. Are any of the family members under a certain petition to migrate abroad? If yes, please indicate the country. Otherwise, does anyone have plans to migrate or work abroad in the next few years?

18. Amount

contributed to educational expenses. 19. Amount contributed to household expenses 20. Number of Helper(s) (salary per helper) 21. Number of Driver(s) (salary per driver)

ASSETS
A. House and Lot
1.

Single Detached Owned

Apartment Rented

Condo Under Mortgage

Townhouse

Location /address

2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13.

Size of lot Number of bedrooms Number of bathrooms Date of acquisition Acquisition cost Fair market value Number of years in residence Monthly rental Bank or agency where loan was secured. Total amount of mortgage Monthly mortgage Number of years to pay for mortgage loan B. Other Properties: Residential Commercial

1. 2. 3. 4. 5. 6. 7.

Description Location/Address Size Date of acquisition Acquired Value Current Market Value Monthly Net Income

C. Cars/Other Motor Vehicles Make 1. Model Year Acquisition Cost Payment Terms (please check) Fully paid Installment Monthly payment (amount ________) Fully paid Installment Monthly payment (amount ________) Fully paid Installment Monthly payment (amount ________)

2.

3.

D. Household Items Fully Paid? Installment Basis? (indicate number of months / years to pay)

Indicate number

Date Acquired

Acquisition Cost

Monthly Payment

TV set (__) Entertainment system / DVD or HD player (__) Ipod / MP3 player (__) Personal computer / laptop (__) Refrigerators (__) Detachered freezer (__) Microwave oven (__) Airconditioner (__) Piano (__) Electric / Gas range (__) Washing machine (__) iPad / Tablet (__) Cellular phone (__) Landline telephone (__)

FAMILYS FINANCIAL STATUS


A. Monthly Gross Family Income
1. 2. 3. 4. 5. 6. 7. 8. 9.

Total Compensation Income (Father/Mother/Sister/Brother) Income from Business Income from Land Rentals Income from Residence/Building Rentals/Lease Retirement Pension Commissions Support from Relatives Bank Deposits : a. Savings/Current b. Bank Placements/Investments c. Bonds/Treasury bills d. Foreign Currency Deposit

Php

Stocks indicate bank, branch and balance of account/s as of current month and year. 11. Others (Specify) Total
e. 10. Kindly

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B. Monthly Gross Family Expenses House rental Car loan amortization 3. Other loan amortizations (specify) 4. School tuition 5. School bus fares 6. Transportation and gasoline 7. Educational plan premiums 8. Insurance policy premiums 9. SSS / GSIS / PAG-IBIG 10. Withholding tax 11. School and office uniforms and clothing 12. Electricity 13. Telephone and mobile phone 14. Water 15. Cooking gas 16. Helpers salary 17. Drivers salary 18. Medicines 19. Health insurance premiums 20. Doctors fees and consultation 21. Hospitalization 22. Groceries 23. Other food expenses 24. Entertainment and recreation 25. Other expenses, please specify:
1. 2.

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Total

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* If the amount of total expenses is higher than your indicated income, kindly justify in your letter how the deficit is covered.

C E R T I F I C A T I O N This is to certify that all the information given is accurate. We are aware that any false data will b e a ground for disapproval or cancellation of a grant. We also authorize the school in charge to verify the information given.
____________________________________ Signature over Printed Name of Father ______________________________________ Signature over Printed Name of Mother

____________________________________ Signature over printed Name of Student/Applicant

_________________________________________

Date Signed

Recommendation Form
Name of Applicant : ___________________________________

1. In what capacity have you known the applicant? For how long? ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ 2. Describe the applicants strong points or aspects for improvement as a student? As a person in general? ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ 3. Describe the financial situation of the applicants family? ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ 4. Has the applicant been granted assistance in any form during high school? ___________________________________________________________________________________ ___________________________________________________________________________________ 5. Is the applicant applying for other private or government scholarship grants? If yes, give details. ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________
I strongly recommend the applicant for: FULL PARTIAL ( ____% ) Merit Scholarship __________ Financial Assistance __________ I do not recommend the applicant. ____________________________________ Signature over Printed Name ____________________________________ Position ______________________________________ School
_________________________________________

Date