City Government of Pasig

Office of the City Mayor

Application for RENEWAL of Pasig City Scholarship

AFFILIATIONS
___​ ​4Ps ___ ​PWD ID Number​:
___​ ​Child of Solo Parent ___ ​SK Official ​ 800949
LR Number​: 1
___​ ​Out of School Learner ___ ​None Scholar/ CHIP-in ID No.​:

For SK Officials Only

Position Barangay

CURRENT SCHOOL INFORMATION

Name of School: ​Ccc School Type:​ Private Academic Level:​ College

PERSONAL INFORMATION
Source Income, ​if any​:​ None
Name of Applicant

Last Name: ​Gaballo Given Name: ​Victor Middle Name: ​Del mundo

Gender: ​Male Date of Birth: ​5/17/1999 Civil Status: ​Single Religion: ​Roman Catholic

Mobile Number: ​09463557629 email Address: ​vjgaballo12@gmail.com

VOTING RECORD
Are you a registered voter?​ ​Yes

HOME ADDRESS

Unit No. House Number Street Name Barangay

82 Tramo Sta. Lucia

FAMILY INFORMATION

Name Date of Birth Occupation Grossn Monthly Income

Father Victor Gaballo Sr. 11/8/1955 Vendor 6000

Mother Ma.fe gaballo 10/11/1962 Vendor 6000

Guardian, ​if any Ma.fe gaballo 10/11/1962> 6000

COMMUNITY SERVICE

Community Service :
EsP :

ACCEPTANCE OF TERMS
We affirm that the facts herein provided are true and correct as of the date hereof. We hereby authorize the Pasig City Scholars Office and its authorized
representatives to verify the information submitted. We understand that if awarded the benefits under the PCS, any false statement, omissions, or
misrepresentation made in this application form may result to the immediate withdrawal of the scholarship grant.

______________________________ ______________________________
Signature of Applicant Signature of Parent/ Guardian
over Printed Name over Printed Name

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SUMMARY OF RATINGS
Financial [ ] Passed [ ] Failed Values Education​ ___________________ RANKING/ SCORE:​ __________
Academic Rating _____________________ Interview ​[ ] Passed [ ] Failed
Interviewed by _____________________ Checked/ Assessed by​ _______________