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Scholarship Application Form Revised 2023 Final

This document is a scholarship and financial aid application form for Ateneo de Naga University, intended for applicants' parents to request financial assistance based on need and academic performance. It outlines the necessary information and documentation required for submission, including personal statements, income tax returns, and school certifications. Confidentiality is emphasized, and misrepresentation may lead to disapproval or cancellation of the application.

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nucosjohnkayle32
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15 views5 pages

Scholarship Application Form Revised 2023 Final

This document is a scholarship and financial aid application form for Ateneo de Naga University, intended for applicants' parents to request financial assistance based on need and academic performance. It outlines the necessary information and documentation required for submission, including personal statements, income tax returns, and school certifications. Confidentiality is emphasized, and misrepresentation may lead to disapproval or cancellation of the application.

Uploaded by

nucosjohnkayle32
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 5

Photo of the

applicant
(2” x 2” White
Background)
SCHOLARSHIP/FINANCIAL AID APPLICATION

1. This application form should be accomplished by the applicant's parents seeking financial
assistance. It must be answered carefully and completely.

2. Scholarship grants and other financial aid at the Ateneo de Naga University are given based on the
applicant's financial needs and academic performance. The Ateneo seeks to help families carry
costs that normally would be beyond their financial resources. In other words, financial aid is
sharing a burden. Thus, the Ateneo expects that families will help carry that part of the burden of
their children's education that lies within their means.

3. All information will be kept strictly confidential. Misrepresentation of information requested in


this questionnaire will be considered a reason for disapproval or cancellation of the request.

4. Applicants may be called for an interview.


5. Submit the following with this application form:
i. On a separate sheet, write a detailed personal statement about the family's financial situation
and the reason for the request.
ii. Photocopy of your latest Income Tax Return or BIR Certification for Tax Exemption
iii. Certification from the Senior High School Principal that s/he belongs to the top 20% of the
graduating class and ranks in their chosen strand. (for new students)
iv. Photocopy of SHS Report Card or Form 138 of your son/daughter (for new students)
v. Photocopy of the latest Scholastic Report Card of your son/daughter (for continuing students)
vi. Photos of the interior and exterior of the house Certified by the Barangay Captain
STUDENT Surname First Name M.I.
NAME

Nickname Gender Age Birthdate (month/day/year) Birthplace

Civil Status Religion Home Telephone No. Mobile No. E-mail Address

Street No., Subdivision/Barangay City/Municipality

Permanent
Address Province Country Zip Code

Preferred Course If in Ateneo, College Department: Course and Year

Page 1
Senior High School Last Attended: SHS Strand: SHS Gen. Ave.:

School Address: Type of S chool: O Private O Catholic O Public


Region: Year Graduated:
Rank in the chosen SHS strand:: Number of SHS Graduates:

AWARDS RECEIVED

Academic Awards Non-Academic Awards

SENIOR HIGH SCHOOL


CO-CURRICULAR/EXTRA-CURRICULAR/RELIGIOUS/COMMUNITY INVOLVEMENTS
Activity/Organization Role/Position Dates Held Awards Received

Hobbies/Interests: Skills/Talents:

Father's Last Name First Name M.I. O Living O Deceased O OCW


Name
Occupation: Monthly Salary: Employer's Name:

Employer's Address: Office Telephone No.:

Mother's Last Name First Name M.I. O Living O Deceased O OCW


Name
Occupation: Monthly Salary: Employer's Name:

Employer's Address: Office Telephone No.:

Guardian's Last Name First Name M.I. Relation:


Name

FAMILY FINANCIAL STATUS

Annual Income (Father, Mother, Guardian and others contributing: Php

PERMANENT RESIDENCE

Location O Home O Apartment


Size of lot O Owned O Rented
a) If rented, how long in this place? Monthly rent:
b) If owned, by whom: When acquired:
Cost when acquired Php Present market value Php
Amount of mortgage unpaid Php Monthly mortgage payment Php
c) No. of bedrooms No. of baths/toilets No. of helpers/drivers

Page 2
OTHER PROPERTIES OWNED (Residential, Commercial, etc)

Description/Use Location Size When Value at Present Yearly


Acquired Acquisition Market Net
Value Income

HOUSEHOLD POSSESSIONS

When Acquired Acquisition Balance to be Monthly


Cost paid Payment
Air conditioner
Desktop Computer
Laptop
Refrigerator/Freezer
Television set
Car: Make Model Year

Motorcycle: Make Model Year

OTHER SOURCES

O Business O Home Industry


Nature of Business: Capital Invested:
No. of Employees: Annual Net Profit:
O Farmlands O Fishponds
No. of hectares: Types of crops/Fish: No. of workers:
Approximate net profit per hectare per year:
FAMILY INSURANCE POLICIES

Nature of Policy Company Amount of Yearly premium Monthly Payment


Insurance

Page 3
LIABILITIES

Payee Purpose of Loan Amount of Date of Maturity Amount still Monthly


Liability Payable Payment

CHILDREN IN SCHOOL AND NOT STUDYING


(Eldest to youngest)
Name Age Civil Status Year/Grade School Attended Yearly Paid by whom?
Tuition

OTHER DEPENDENTS LIVING IN THE HOUSE

Name the persons (relatives, friends, etc.) other than yourselves who help with the household and educational
expenses and indicate the extent of financial support (for whom, how much?)
Name Kind of Support Name of Amount of Support
Beneficiary

CHILDREN WHO ARE PRESENTLY ON SCHOLARSHIP AT ATENEO

Name Type of Scholarship Name of Sponsor Scholarship Benefit

Page 4
Name:

Permanent Address:

SKETCH OF YOUR COMPLETE ADDRESS


(Please indicate landmarks for easy reference)

PLEASE DO NOT FILL OUT THIS PART OF THE FORM.

Date received:

Remarks:

Received by:

SIGNATURE OVER PRINTED NAME

Page 5

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