UNIVERSITY OF THE PHILIPPINES

OFFICE OF SCHOLARSHIPS AND FINANCIAL ASSISTANCE

APPLICATION FOR SCHOLARSHIP/STUDY GRANT 2x2

ID Photo
_______________________________________________________________
(Scholarship/Study Grant being applied for)

Name of applicant: _____________________________________________________________________

(Last Name) (First Name) Middle Name
Student No.: _____________________ Course: _____________________ Year level: _______________

Please indicate: Degree course at the time of application: ( )1st degree ( ) 2nd degree
With Intention to shift ( ) Yes ( ) No. If yes, specify which course ___________________
Shiftee/transferee ( ) Yes ( ) No. If yes, specify ____________________ When: ___________
No. of units left at the time of application: __________
Are you on MRR? ( ) Yes ( ) No

Place of Birth: _______________Date of Birth: ______________Citizenship: _________Civil Status: _______

Permanent Address: ___________________________________Zip Code: _________Tel. No. _____________
Present Address: _____________________________________Zip Code: _________Tel. No. _____________
Campus Address: _________________________Mobile No. _____________Email address: ____________

Father: _____________________________ Occupation: _________________ Gross yearly salary: _________

If retired year of retirement: _____________If with pension, state amount received monthly ______________
Mother: ___________________________ Occupation: _________________ Salary: ________
If retired year of retirement: _____________If with pension, state amount received monthly ______________
If both parents are unemployed, state reason/s: _______________________________________________
Source/s of livelihood: ___________________________ Amount earned yearly: ____________________
Or contributions/support from other sources like relatives, etc. ___________________________________
If self employed, state type of business _____________________ Earnings per year: P________________
Guardian: _________________ Occupation: _______ Salary: _______ Relation: _________
For Employed Applicants:
Occupation: _________________ Employer: ___________________ Gross yearly salary _________________
State last five (5) years of employment, please start with the most recent)
Employer: Address & Tel No. Period of Employment Reason for leaving
______________________ _______________________ ______________________ _______________
_____________________ _______________________ ______________________ _______________
For Married Applicants:

Spouse’s Name: ___________________________ Occupation ________________ Salary ____________

Name of Children: Age:
__________________________________________ ______________
__________________________________________ ______________
__________________________________________ ______________
_________________________________________ ___ ______________

(For unmarried applicant only)

Name of Brothers & Sisters Age Civil Status If working state income
__________________________________________ _____ _________ ____________
__________________________________________ _____ _________ ____________
__________________________________________ _____ _________ ____________
__________________________________________ _____ _________ ____________
(Use additional sheet if necessary)
Please answer:
1. Are you currently enjoying any scholarship, financial assistance, or other privileges?
a) From University? Yes ( ) No ( ).
b) Outside the University? Yes ( ) No ( ).
If the answer is “yes” to either question, please specify:
Name of Scholarship/Grant Nature of scholarship/ Grant Benefits Received
_____________________________ __________________________ ____________________
_____________________________ __________________________ ____________________
2. Do your parents:(a.) own real properties? Yes( ) No( ).
If yes, specify: _________________________________ Current Market value: _______________
(b.) Others: (ex. Cars, stocks, etc.): __________________ Current Market value: _______________
3. If applicant’s parents are separated, state support received from father/mother:__________________
4. If applicant is married but separated:
State if husband/wife giving support: _________________________ Amount: _________________

I hereby certify that all the statements above are true and correct.

__________________________________
Signature over Printed Name of Applicant
____________________
Date
For OFFICE OF SCHOLARSHIPS & FINANCIAL ASSISTANCE personnel only:
Date Received: ______________________________________________
Received by:________________________________________________

Requirements (Photocopy Only)

1. One photo 2”x 2”
2. Income Tax return and W2 of parents. If applicant is working, his/her Income Tax Return and W2, if married,
attach also ITR and W2 of spouse (If income is derived from business, attach Income Statement), BIR
Certificate of Exemption
3. For applicants already enrolled in the University, please submit also the following:
(a) Current Form 5
(b) True copy of grades/CRS printout
(c) Certification of year level standing from College
(d) For Graduate students: transcript of academic records, program of study
4. Clearance from Student Disciplinary Council
(From former school if incoming freshman)
5. Birth Certificate.
6. Others (i.e., Presidential, Leadership, Foreign etc.):
Nomination from home government; letter of financial support; 3 letters of recommendation from former
professors, recommendation/certification of good moral character from former/current employers; list of
accomplishments arranged by levels, i.e. in high school, college and community duly authenticated by the
appropriate authority; Notice of Admission or Form 5 if already enrolled; Certification from the College of
your remaining units and that you are not on MRR.