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QUEZON CITY
Office of the City Mayor
Scholarship and Youth Development Program
APPLICATION FORM
00 ss
Photo
2” X 2”
With nameplate
ID Picture taken
within the last 6
months
Instructions: READ ADMISSION AND APPLICATION REQUIREMENTS AT THE BACK PAGE. Fill in all the required information. DO NOT leave an item blank. If
item is not applicable, indicate “N/A”. All applications must be filed PERSONALLY by applicant.
A. Personal Information
Last Name Ext Name M.I
i.e JR/SR, if any (D,P, or DP)
Name of School Basic Education / Academic Award or Honor Period of Attendance GWA
(Write in full) Degree / Course Received From To GENERAL WEIGHTED AVERAGE
G. Consent
I hereby give my consent on the general use and sharing of personal and sensitive personal information I have provided herein
in accordance with the declared objectives of the Organization/Party at its inception and as adopted annually. The Organization/Party
can collect, process, store, update, or disclose this information for legitimate purposes and for implementing the programs of the
Organization/Party.
I consent to the continuous use and retention of this information by the Organization/Party for a period of five (5) years from the
receipt of the latter of my notice of severance from the Organization/Party.
_____________________________________________ __________________________
SIGNATURE OVER PRINTED NAME OF APPLICANT DATE