Application for Scholarship Form

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Student Scholarship and Aid Division SILLIMAN UNIVERSITY 6200 Dumaguete City Application for Special Scholarship/Financial Assistance

FULL NAME: Last First Middle

PRIORITY COURSE: MOBILE PHONE NO.: BIRTHDATE: AGE: RELIGIOUS AFFILIATION: GENDER HOME ADDRESS: PHONE NO.: DUMAGUETE CITY ADDRESS: PHONE NO.: HIGH SCHOOL GRADUATED FROM: YEAR GRADUATED: NO. OF GRADUATES: GRADUATION HONOR/RANK: HIGH SCHOOL GRADE AVE (If continuing student): UNIT LOAD: TQPA Please list the awards, honors and citations you received in 4th High School and in College (if continuing), and indicate inclusive years: Year Award Nature/Description of Award

FATHER’S NAME : MOTHER’S NAME: NO. OF SIBLINGS : Sibling’s Name

AGE OCCUPATION AGE OCCUPATION PARENTS’ COMBINED ANNUAL INCOME : Age Highest Educational Attainment Current Employment Status

Aside from parents, state the other persons helping your studies while in Silliman: a) Relationship b) Relationship In what way, Please check: ( ) School fees ( ) Board & Lodging ( ) Allowance ( ) Others Name and address of two persons not related to you whom you know can honestly recommend you: a) b) Address Address

I hereby certify that the above information is true and correct to the best of my knowledge and ability.

Signed: Applicant’s Signature

Date Filed:

APPLICATION REQUIREMENTS For New Applicants: 1. Accomplished application form accompanied by a personal letter of application. On the blank space below, briefly write an essay about yourself, your goals in life and why you need this special scholarship and what it will mean to you if granted. Photocopy of Form 138 (High school grade of 88% or better with no grade below 80%). Certification of honor/graduation rank from the High School Principal. Certified TQPA of 2.5 or better. (For continuing students). Latest income tax return or Certification as non-filer from the local BIR. Recommendations from two (2) uninterested reliable persons from his/her community but not politicians and relatives, stating the economic condition of the family. Endorsement from the College Dean. (For continuing students) Certification from the District Conference stating that her/his parent/s are practicing pastor/s to a local church (state the name & location of the church ) and the duration of the appointment. (for UCCP Pastor’s children)

2. 3. 4. 5. 6. 7. 8.

The above requirements must be submitted on or before April 30, 2012. All applicants must submit themselves for interview to three (3) members of the Student Aid Committee.

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