VERIFICATION SLIP

_______________________________________________________
NAME OF SCHOOL/ISTITUTION

TO: CASUR PROVINCIAL SCHOLARSHIP PROGRAM

NAME: OF STUDENT: ____________________________________________________
COURSE/YEAR LEVEL: ____________________________________________________

PLEASE CHECK:
Presently enjoying other scholarship
Type:

NOT enjoying any scholarship

VERIFIED/ATTESTED BY:

SCHOOL SCHOLARSHIP COORDINATOR/ADMISSION

(Signature Over Printed Name)
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Republic of the Philippines
PROVINCE OF CAMARINES SUR
CAMSUR SCHOLARSHIP AND FINANCIAL EDUCATION ASSISTANCE PROGRAM
Provincial Capitol Complex, Cadlan, Pili

______________________________________________________________
NAME OF SCHOOL/ COLLEGE//UNIVERSITY

______________________________________________________________
ADDRESS

Name of Student: _________________________________________ Age: __________ Sex: ____________

Complete Address:_________________________________________ Contact No. ________________________
Parent/Guardian: _________________________________________ Contact No. ________________________
Course: __________________________________________________ Birthday: __________________________

Year/Grade Level ( _______________ ) SY: ( ________________ ) Semester: ( _________________ )

SUBJECT CODE SUBJECT DESCRIPTION UNIT AMOUNT

TOTAL

__________________________________ __________________________________________
Student’s Signature SCHOOL REGISTRAR/COLLEGE DEAN
(Signature Over Printed Name)