V I C S A L F O U N D AT I O N , I N C O R P O R AT E D 2” x 2”

CD Seno & WO Seno St., Guizo, Mandaue City PHOTO

Tel. No. (63) (32) 236-8390 loc. 248

SCHOLARSHIP APPLICATION
INSTRUCTIONS : 1. Please write in block letters.
2. Do not leave any item blank, write N.A. if information needed does not apply to you.
I. PERSONAL INFORMATION

SURNAME GIVEN MIDDLE NAME

CITY ADDRESS
PROVINCIAL ADDRESS
AGE SEX CIVIL STATUS
DATE OF BIRTH PLACE OF BIRTH RELIGION
LANDLINE NO. MOBILE NO. EMAIL ADD
II. EDUCATIONAL BACKGROUND
HONORS/AWARDS
LEVEL NAME OF SCHOOL ADDRESS INCLUSIVE YEARS
RECEIVED
ELEMENTARY

JUNIOR HIGH SCHOOL

SENIOR HIGH General

ABM SPORTS
HUMSS STEM
SCHOOL Academic
*TRACKS:
ARTS & DESIGN TVL please specify: ________________

TERTIARY EDUCATION
SCHOOL INTENDED TO ENROLL COURSE

FACTOR(S) THAT MOTIVATED YOU TO CHOOSE YOUR COURSE:

III. FAMILY BACKGROUND

FATHER MOTHER CONTACT PERSON IN CASE OF

NAME & AGE EMERGENCY

EDUCATIONAL ATTAINMENT NAME

SCHOOL LAST ATTENDED RELATIONSHIP
OCCUPATION ADDRESS
EMPLOYER
MONTHLY INCOME CONTACT NO.
BROTHERS & SISTERS (eldest to youngest order in the family)

OCCUPATION &
CIVIL EDUCATIONAL SCHOOL LAST
NAME RELATIONSHIP AGE SEX MONTHLY
STATUS ATTAINMENT ATTENDED
INCOME

BROTHERS/SISTERS ENJOYING SCHOLARSHIPS (IF ANY)

NAME SCHOLARSHIP SCHOOL ADDRESS COURSE & YEAR

IV. CHARACTER REFERENCES (name at least 3 persons, other than your family, who can vouch for your moral integrity)
NAME NAME NAME
ADDRESS ADDRESS ADDRESS
COMPANY COMPANY COMPANY
POSITION POSITION POSITION
CONTACT NO. CONTACT NO. CONTACT NO.

This is to certify that the foregoing information and statements are true and correct to the best of my knowledge and that I am fully aware that
any false information that I have intentionally or negligently written can cause the disapproval/cancellation of my scholarship.

___________________________________________ _________________________________
Signature over printed name of the Applicant Date Signed

THIS FORM MAY BE REPRODUCED

*Senior High School Tracks : HUMSS—Humanities & Social Sciences
STEM– Science, Technology, Engineering & Mathematics
ABM– Accountancy, Business & Management
TVL—Technical– Vocational– Livelihood:
(TVL specializations: Agri-Fishery, Home Economics, Information &
Communications Technology, Industrial Arts and TVL Maritime)

QUALIFICATIONS
 Must be a graduate or a graduating student of any public senior high school, with general average not lower than 88% and
with no grade per subject lower than 80%;

 Must be of good moral character and possess leadership skills;

 Annual Gross Income of both parents/ guardians must not be more than Php300,00.00 or for a family with single earner/
guardian , of not more than Php150,000.00.

REQUIREMENTS
Please follow these instructions carefully:

1. Only application with complete requirements will be accepted and processed;

2. Enclose all requirements in one (1) white folder and fastened on the left side;
3. Write your full name on the right side in this format: SURNAME, GIVEN NAME MIDDLE INITIAL;
4. Provide copies of the following:
Quantity Description
1 Photocopy Applicant’s Birth Certificate
Applicant’s Senior High School Report Card (indicating at least the 3rd quarter assess-
1 Certified True Copy
ment/grade)
1 Certified True Copy Applicant’s Good Moral Certificate
Parents’/Guardians’ Latest BIR Income Tax Return or BIR Tax Exemption Certificate
1 Photocopy
for non-taxable income earners
1 Photocopy Applicant’s Barangay Clearance
1 Piece Applicant’s 2”x2” Colored Picture

SCHOLARSHIP PRIVILEGES AND CONDITIONS

The following are our privileges and conditions for those who are accepted in our scholarship program after passing all
the screening procedures namely: paper screening, examination, pre-interview, final interview and home visit::

a. Full payment of TUITION and OTHER SCHOOL FEES per semester as billed by the Accounting Office;
b. Monthly allowance of Php 3,000.00;
c. Book allowance of Php3,000.00 per semester.
d. Graduation fee reimbursement up to Php2,000.00 for scholar-graduates.

Items b, c and d will be given directly by the foundation to the scholar concerned via deposit to his/her Wealthbank
Savings Account.

TERMS AND CONDITIONS OF THE SCHOLARSHIP PROGRAM

a. Shall carry the regular semestral academic load as specified in his/her curriculum;
b. Must maintain a semestral grade point average of not lower than 2.0 or its equivalent and with no grade below 2.5 or NC
(No Credit) and NG (No Grade) per subject;
c. Must not drop or withdraw any subject nor cancel his/her enrollment for the semester during which he/she enjoys the
scholarship;
d. Must not accept any other scholarship grant while enlisted in this scholarship;
e. Must not accept any kind of employment while on scholarship, the intent is to devote full time on his/her studies; and
f. Must not commit fraud, dishonesty, crime, scandalous or immoral behavior nor violate the rules and regulations of the
school.
g. Failure to attend classes due to poor health, pregnancy, disciplinary action and any conduct which to our evaluation will con-
tradict the objectives and standards of the FOUNDATION and the SCHOOL shall merit termination of the Scholarship Grant.

Violation of any of the terms and conditions aforementioned shall be considered as a ground for termination of the Scholarship
Grant.

Acknowledged By:

______________________________________ ________________________
Signature over printed name of the Applicant Date Signed

Revised Form No. 7-2025/MCK

Cebu Maharlika Development Corporation