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LIFELINE ASSISTANCE FOR NEIGHBORS during the Application Period.

IN-NEED Incompletely filled-up Scholarship


SCHOLARSHIP CHECKLIST Application Forms or those with
Basic/SUC/LCU/Basic + SUC/LCU incomplete requirements shall NOT be
accepted, or IF inadvertently accepted,
it shall NOT be processed.
Name:
LIFELINE ASSISTANCE FOR NEIGHBORS
____________________________________________ IN-NEED
_______________ SCHOLARSHIP CHECKLIST
School: Basic/SUC/LCU/Basic + SUC/LCU
____________________________________________
_______________
Name:
CHECKLIST OF REQUIREMENTS TO BE
SUBMITTED (2 sets) ____________________________________________
_______________
_____ Filled-up Application Form with 2X2 School:
Recent Picture ____________________________________________
_____ Enrolment Form for the Current _______________
Semester/Term with Official Receipt, if
applicable CHECKLIST OF REQUIREMENTS TO BE
_____ Authenticated or True Copy of Grades SUBMITTED (2 sets)
last semester, with school seal/official
signature (for trimester, grades for the _____ Filled-up Application Form with 2X2
past 2 terms) Recent Picture
_____ High School Card/Any proof of having _____ Enrolment Form for the Current
graduated from your stated High School Semester/Term with Official Receipt, if
(for Freshmen/New Applicants) applicable
_____ Certificate of Good Moral Character _____ Authenticated or True Copy of Grades
(Issued within the year) last semester, with school seal/official
_____ School ID (back to back photocopy in a signature (for trimester, grades for the
single page) past 2 terms)
_____ Other necessary documents to _____ High School Card/Any proof of having
facilitate the processing of your graduated from your stated High School
scholarship application (Transcript or (for Freshmen/New Applicants)
True Copy of Grades since start of _____ Certificate of Good Moral Character
college for New Applicants who are (Issued within the year)
continuing students, Scholarship _____ School ID (back to back photocopy in a
Voucher, EVS Certification, F137, single page)
Course Curriculum, Birth Certificate, _____ Other necessary documents to
etc.) facilitate the processing of your
_____ Voters Certification issued by scholarship application (Transcript or
COMELEC issued after May 2013 True Copy of Grades since start of
showing that at least one of the parents college for New Applicants who are
of the applicant is a registered voter continuing students, Scholarship
_____ Voters Certification of the applicant Voucher, EVS Certification, F137,
(for 18 years old and above) Course Curriculum, Birth Certificate,
etc.)
Instructions _____ Voters Certification issued by
1. Please submit your Scholarship COMELEC issued after May 2013
Application at the Senator Renato showing that at least one of the parents
"Compaero" Cayetano Memorial of the applicant is a registered voter
Science and Technology High _____ Voters Certification of the applicant
School (SRCC or Cayetano Science), (for 18 years old and above)
Pamayanang Diego Silang, Brgy. Ususan,
Taguig City on the dates of acceptance Instructions
of application. Check the Scholarship 1. Please submit your Scholarship
Secretariat (Taguig) FB Account and Application at the Senator Renato
www.taguig.gov.ph regularly for "Compaero" Cayetano Memorial
announcements regarding dates and Science and Technology High
venue. School (SRCC or Cayetano Science),
Pamayanang Diego Silang, Brgy. Ususan,
2. Please come with 2 (two) sets of all Taguig City on the dates of acceptance
the documents. All photocopied of application. Check the Scholarship
documents to be submitted should be Secretariat (Taguig) FB Account and
faithful reproduction of the original. www.taguig.gov.ph regularly for
Bring the original copies of announcements regarding dates and
documents for validation purposes. venue.
Ask for the Receiving Copy upon
submission. 2. Please come with 2 (two) sets of all
the documents. All photocopied
3. Please fill up all the data documents to be submitted should be
requirements in the Application faithful reproduction of the original.
Form and submit all the Bring the original copies of
documentary requirements needed documents for validation purposes.
Ask for the Receiving Copy upon during the Application Period.
submission. Incompletely filled-up Scholarship
Application Forms or those with
3. Please fill up all the data incomplete requirements shall NOT be
requirements in the Application accepted, or IF inadvertently accepted,
Form and submit all the it shall NOT be processed.
documentary requirements needed
OFFICE OF THE MAYOR
Taguig City, Philippines

LIFELINE ASSISTANCE FOR NEIGHBORS IN-NEED


SCHOLARSHIP APPLICATION FORM
Basic/SUC/LCU/Basic + SUC/LCU

Instructions:
1. PRINT all entries.
2. Place an X in the appropriate blank provided.
Date:__________________________________

SCHOLARSHIP APPLIED FOR

_____ Basic Scholarship _____ SUC/LCU _____ Basic + SUC/LCU


_____ New Applicant _____ Renewing Applicant
School Year: _________________ Semester: _____ 1st Sem _____ 2nd Sem

Number of semesters that you have benefitted from the Scholarship:


_______________________

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

FATHER MOTHER HUSBAND/WIFE


( ) Living ( ) ( ) Living ( ) (If Married)
Deceased Deceased
Name
Address
Contact No.
Occupation
Place of
Work
Highest
Educational
Attainment
Ave.
Monthly
Income

Number of siblings in the family (including applicant):___________________. Please fill out


information below about your siblings:
Age Marit Highest If working, indicate
al Educational where they work &
Name Statu Attainment their average monthly
s (M (as of date) income
or S)

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

Investing in education, investing in the Citys Foundation!