OSA-SFAD FORM NO.
1a
SCHOLARSHIPS AND FINANCIAL ASSISTANCE DIVISION
Office of Student Affairs
UPLB, College, Laguna
APPLICATION FOR ___________Semester SY 201___201___
__________________________________________________________________
(Scholarship/Study Grant being applied for)
Student No:________________College/Classification/Course:________________________________________________
Name of Applicant (family name first):______________________________________________Citizenship:____________
Place and Date of Birth:______________________________________________ Civil Status: ___________________
Permanent Address:____________________________________________________ Telephone Number:_____________
Campus Address:___________________________________________ Mobile Number:___________________________
e-mail Addresss:____________________________________________ Other Contact Number:_____________________
Family Background:
Father:__________________________________ Occupation:______________Annual Gross Income:________________
Mother:_________________________________ Occupation:______________Annual Gross Income:________________
(If both parents are unemployed, state source of income/livelihood)
Brother and Sister:
Age Civil Status Name of School Scholarship Enjoyed If working, state
Income
_____________________ ___ ________ ___________________ ________________ _____________
_____________________ ___ ________ ___________________ ________________ _____________
_____________________ ___ ________ ___________________ ________________ _____________
_____________________ ___ ________ ___________________ _______________ _____________
(use additional sheet if necessary)
If applicant is married Name of Children Age Checklist of documents:
___ ITR/Affidavit
Name of Spouse:_____________________ ___________________ ____ ___ TCG (previous semesters)
Occupation:_________________________ ___________________ ____ ___ Form 5
Annual Gross Income:_________________ ___________________ ____ ___ Birth Certificate
___ HS cert of ranking
P_________ ___________________ ____ ___ Form 138
___ Letter of recommendation
Educational Background (for freshman applicant): For Old Student Applicant
Last semester enrolled/completed: ___ Semester 20____20____
Name of High School:__________________________________ Previous Semesters Ave:__________ Units Earned: _________
School year graduated:_________________________________ General Weighted Ave. ___________Total Units Earned______
Rank in graduating class:________________________________ Current Classification:_________________
Total number of graduates:______________________________ Certified Correct by:
General Average:______________________________________ ____________ ___________________________
Date College Secretary
Please answer:
1)Are you enjoying any scholarship, financial assistance, employment or other privileges in the university?____________
Outside the university?________, if the answer is yes to either or both, specify nature and amount of grant or
salary ___________.
2)Are you staying: (a) with parents/guardian? (yes or no) _____________
(b) with relatives? (yes or no) ______ if yes, where? ________________________
(c) Boarding house? (yes or no) _____ if yes, where?___________________
3)Do your parents (a) own real properties? (yes or no)____ if yes, Market Value (MV) P_______
(b)rent? (yes or no)_______if yes, monthly rental P________
I hereby certify that all the statement above are true and correct:
Signature of Applicant: __________________________ Date:__________________ (cont at the back >)
Please attach to your application the following:
1. One (1) photo 2 x 2
2. Income Tax Return (ITR) of parent/s and/or other family members; if not gainfully employed, execute an
affidavit as to the source and amount of income earned for the previous year and attach Barangay Certificate
that family has no fixed income
3. For applicants already enrolled in the University, please submit also the following:
a) Form 5 (current semester)
b) True Copy of Grades (TCG) during the previous semester/s)
c) For graduate students, transcript of records, program of study
4. Birth certificate
Additional requirement if applicant is a New Freshman:
1. Principals certificate on students rank and size of graduating class
2. Form 138
With revisions : 28Feb2017
