Académique Documents
Professionnel Documents
Culture Documents
Instructions:
1. PRINT all entries.
2. Place an X in the appropriate blank provided.
Date:__________________________________
PERSONAL INFORMATION
Name:
_________________________________________________________________________________________
_______________________
(Last Name) (First Name) (Middle
Name)
Address:
_________________________________________________________________________________________
____________________
Barangay: _________________________________________ Years of Residency in Taguig
(applicant): _________
Mobile/Landline Phone Numbers:_________________________________________________
Age: _________________
Place of Birth: ____________________________________ Date of
Birth:___________________________________________
Gender: ____________ Marital Status: ____________ Religion:
________________________________________________
E-mail Address:
______________________________________________________________________________
Residence: _____Owned by family _____Owned by relatives _____Renting ____Paying-to-
own
_____Others (pls specify): _________________________________________________
If renting or paying-to-own, how much are you paying monthly?:
P_________________________
Have you been the object of any disciplinary action in school? ____Yes _____ No
Have you been accused or convicted of any offense/crime? ____ Yes _____ No
If the answer to any of the last 2 questions above is Yes, please provide details:
_________________________________________________________________________________________
_______________________________
EDUCATIONAL BACKGROUND
Course:
_________________________________________________________________________________________
______________________
Year Level: _______ Graduating this semester? _____Yes _____No Grade Ave. last
sem:_______________
Regular duration of Course: _____5 years _____4 years _____3 years _____2 years
_____Others (specify)
____________________________________________________________
How many semesters more to go before you graduate, including the current sem/term?
_________________
School:__________________________________________________________________________________
______________________________
School Address:
_________________________________________________________________________________________
____________
School Year
Type Started Honors/Award
Name of Schools (Indicat School Address Year s Received
Graduated From e if (Barangay and Graduat (if any)
Public City/Municipality) ed
or
Private)
High School:
Elementary:
FAMILY BACKGROUND
I hereby certify that ALL the answers given above are TRUE and CORRECT to
the best of my knowledge and that the attached documents are faithful reproduction of
the original copies. I further acknowledge that ANY ACT OF DISHONESTY OR
FALSIFICATION MAY SERVE AS A GROUND FOR MY PERPETUAL
DISQUALIFICATION from this Scholarship Program.
I also understand that this submission of application does NOT automatically
qualify me for the scholarship grant and that I will abide by the decision of the L.A.N.I.
Scholarship Management.
Thank you very much.
_____________________________________________________________________________
_______________________________
Printed Name & Signature of Applicant
Date
Attested by:
_____________________________________________________________________________
______________________________
Printed Name & Signature of Parent/Legal Guardian
Date
Rev.3.8.15