LANI Scholarship Application Form-College & Board Takers-Rev.1.4.13

OFFICE OF THE MAYOR Taguig City, Philippines Recent 2x2

L.A.N.I. SCHOLARSHIP APPLICATION FORM For College, Tech-Voc, and Bar/Board Reviewees Only Instruction: 1. PRINT all entries 2. Place an X in the appropriate blank provided ____ New Applicant

ID Picture

Date:_____________________________ Date:_____________________________

____ Renewing Scholarship: _________total units completed last semester

SCHOLARSHIP APPLIED FOR ____ Basic Scholarship ____ SUCs-LCUs Scholarship ____ Full Scholarship ____ Premier/Specialized Premier/Specialized Schools Scholarship ____ Scholarship for Priority Courses & Skills Training ____ Merit Incentive ____ Review Assistance Program PERSONAL INFORMATION Full Name: ____________________________________________________________________________________________________________________ (Last Name) (First Name) (Middle Name) Address: _______________________________________________________________________________________________________________________ Barangay: _____________________________________ E-mail Address: ________________________________________________ Mobile Phone No.:_______________________________ Telephone No.: ________________________ Age: _________________ Date of Birth:______________________ Birth:______________________ Place of Birth: _____________________________ Years of Residency Residency in Taguig: _________ Gender: _____ Marital Status: _________ Citizenship:_______________ Citizenship:_______________ Religion: ___________________________________ Have you been the object of any disciplinary action in in school? ____Yes _____ No Have you been accused or convicted of any offense/crime? offense/crime? ____ Yes _____ No If the answer to any of the last 2 questions above is “Yes ,” pls provide details: ___________________________________________________________________________________________________________________________ Are you working? ___Yes ___ No. Where? __________________________________________ Gross monthly salary: P______________ COURSE and SCHOOL Course: ___________________________________________________________Year Level: Level: __________ Grade Ave. last last sem:_____________ sem:_____________ Are you graduating this sem? ____No ___Yes If yes, are you graduating with honors? ____No ___Yes______________ If no, how many semesters more to go before you graduate, including the current sem? _________ ___________________ School: ___________________________________________________________________________________________________________________________ School Address: ________________________________________________________________________________________________________________ EDUCATIONAL BACKGROUND Schools Attended (start with most recent)

School Type (Indicate if  Public or Private)

School Address

Year Started – Year Graduated

Investing in education, investing in the City’s foundation! 

Honors/Awards Received (if any)

FAMILY BACKGROUND FATHER ( ) Living ( ) Deceased

MOTHER ( ) Living ( ) Deceased

HUSBAND/WIFE (If Married)

Name  Address Contact No. Occupation Place of Work  Highest  Educational  Attainment   Attainment 

 Ave. Monthly Income Residence: _______Owned by family______ Owned by relatives ______ Renting _____Paying-to-own _____Others (pls specify): __________________________ If renting or p aying-to-own, how much are you paying monthly?: P______________ Does the family have any outstanding loan? ____Yes ___ No. If yes, how much (total)? P__________________ What was the loan or loans used for? _____________________________________________________________________________________________________ How much is your latest monthly electric bill?: P______________ How much is your latest water bill?: P_______________ Number of siblings in the family (including applicant):_______. Please fill out information below about your siblings:  Age Name

Marital Status (M or S)

Highest Educational If working, indicate where they  Attainment  (as of  work & their average monthly date) income

I hereby certify that  ALL the answers given above are TRUE and CORRECT  to the best of my knowledge, and the attached documents are FAITHFUL REPRODUCTION  of the original copies. I further acknowledge that  ANY  ANY ACT OF  from this scholarship program. DISHONESTY OR FALSIFICATION MAY BE A GROUND FOR MY DISQUALIFICATION  Thank you very much.

_____________________________________________________________ Printed Name & Signature of Applicant  Date: ____________________________________________________

Attested by:

__________________________________________________________________ Printed Name & Signature of Parent/Legal Guardian

Date: ___________________________ Rev:1/4/13/bel 

Investing in education, investing in the City’s foundation!