Scholarship Application Form ( SY 2019-2020)

General Information:

Last Name__________________First Name_______________Middle Name______________

Sex_______ Age______ Date of Birth______________Religion____________________

Year____________ Course___________________________________________________

Mobile #______________________Landline #____________Email Address______________

Home Address_______________________________________________________________

Do you own or rent your house?________Duration of Stay at Present Address____________

Educational Background:

Elementary:_____________________________________________Yr. graduated:_________

Honors Received:_______________________________________________________

Secondary:______________________________________________Yr. graduated_________

Honors Received:_______________________________________________________

Academic Achievements as PLM Student:_________________________________________

Family Background:

Father’s Name:___________________________________Date of Birth_________________

Occupation:________________Office Address___________________Tel#_______________

Mother’s Name:__________________________________Date of Birth_________________

Occupation:________________Office Address___________________Tel#_______________
Total Monthly Family Income (from all sources):____________________________________

Approximate Monthly Family Expenditure:________________________________________

Details of Family Members (brothers and sisters):

Monthly
Name Age Relationship Education Occupation
income

(Attach a separate sheet if more information is to be provided for any of the questions.)

I certify that all the information provided in this form is true and correct. Any false entry
discovered by the PLMSFI will mean my disqualification from the Scholarship Program.

Signature of Applicant:_______________________ Date:________________

Please attach the following requirements to your signed application form:

a. Letter to PLMSFI stating the reasons why you are qualified to become a scholar
under the PLMSFI scholarship program;
b. Copy of grades during the 1st and 2nd semesters of the previous school year;
c. Income tax returns of parents / guardians, if available;
d. Certification from the Barangay Captain affirming the financial incapacity of the
family to support the applicant’s education;
e. Two (2) latest ID photos (passport size); and
f. Sketch of residence.

Note:
1. Students short-listed will be informed by phone or email to come for an interview.
2. Issuance of this preliminary application form does NOT guarantee the award of a
scholarship.
3. Submit your filled-up application form and other requirements (scanned copies) to
Mr. Rolly Cuico thru email (rollycuico@yahoo.com). Original copies shall be
submitted during the interview.
4. Applicant should at least be in their Sophomore year in PLM, with a GWA of not
lower than 2.25 for old scholars, and 2.5 for new applicants, in both the 1st and the
2nd semester of the previous school year.
5. Applicant should not be a beneficiary of other scholarship program.
6. Siblings of incumbent and former PLMSFI scholars are not eligible for scholarship.