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OFFICE OF THE MAYOR

Taguig City, Philippines


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

Recent
2x2
ID Picture

Date:_____________________________

____ Renewing Scholarship: _________total units completed last semester

SCHOLARSHIP APPLIED FOR


____ Basic Scholarship
____ SUCs-LCUs Scholarship
____ Full Scholarship
____ 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:______________________ Place of Birth: _____________________________ Years of Residency in Taguig: _________
Gender: _____ Marital Status: _________ Citizenship:_______________
Religion: ___________________________________
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, pls provide details:
___________________________________________________________________________________________________________________________
Are you working? ___Yes ___ No. Where? __________________________________________ Gross monthly salary: P______________
COURSE and SCHOOL
Course: ___________________________________________________________Year Level: __________ Grade Ave. last 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: ________________________________________________________________________________________________________________

Schools Attended
(start with most recent)

EDUCATIONAL BACKGROUND
School
Type
(Indicate if
School Address
Public or
Private)

Year
Started
Year
Graduated

Investing in education, investing in the Citys 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

Ave. Monthly
Income
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______________
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 ACT OF
DISHONESTY OR FALSIFICATION MAY BE A GROUND FOR MY DISQUALIFICATION from this scholarship program.
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 Citys foundation!

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