Scholarship Form (OSS-2015)

Bicol University Legazpi City, Philippines
Application for Scholarship/ Financial Grant Acknowledgement
Scholarship/ Financial Grant being applied for: ___________________

_____Semester, SY: ________
Please CHECK Internal External Government Grant
PLEASE TAKE NOTE CAREFULLY

1. Please fill up this form LEGIBLY. Please paste
2. ALL sections must be completed. your RECENT
3. Applications received after the deadline WILL NOT be considered. Passport Size
4. Please attach all ORIGINAL COPY/PHOTO COPY of requirements.
Picture Here
5. Incomplete applications WILL NOT be acted upon favorably by the Office.
6. Applications must be filed in person.
PERSONAL INFORMATION
Last Name First Name Middle Name Gender
TORDILLOS JANSSEN CLAIRE Male Female
Date of Birth Civil Status Cellular Phone Number Email Address
CURRENT STATUS
College/ Campus Degree/ Course/Major Year Level No. of Units Enrolled Student Status
Regular
Irregular
High School Graduated from Date Graduated
If FRESHMAN BUCET Result High School General Average
FAMILY BACKGROUND
Father’s Name Occupation
Mother’s Name Occupation
Annual Family Income PHP Number of Siblings in the Family
House Number Street Barangay
Home Address
Municipality Province Zip Code
House Number Street Barangay

If boarding or staying with
the Relatives Municipality Province Tel/Cellphone Number
AGREEMENT
I HEREBY CERTIFY that all information indicated in this form and on the documents attached in this application for scholarship/ financial grant/ tuition
fee discount are true and correct and that any concealment or misrepresentation of facts therein found will adversely affect my application.
Signature over Printed Name Date
APPLICANT
Signature over Printed Name Date
PARENTS/ GUARDIAN
If the applicant is below 18 years old
NOTICE OF ACKNOWLEDGEMENT
Please produce three (3) photocopies of this notice
STUDENT’s COPY
1 copy for the Registrar, 1 copy for the Student Affairs Coordinator, and 1 copy for the Bookkeeper
Name lege/ Campus
College/ Campus
Course and Year Level

Scholarship/ Financial Grant For Billing
being applied for For Tuition Fee Discount with the percentage of %
Internal
Full Tuition & Other Assessed Fees
External Full Tuition Fee Discount
Government Grant or Financial Assistance
Full Tuition Fee Discount with Matriculation
For Acknowledgement only
C E R TIFICATION
This is to certify that all requirements have been complied with in For the University Scholarship and Date
accordance to BOR Resolution No.40 s 2000 that “only applications Financial Grants-in-Aid Officer _____semester
for scholarship or enrolment with privilege with complete
S.Y. 20____-20_____
requirements shall be acted upon favorably by the BU OSS”.
Office of the Student Services

Scholarship and Financial Grants-in-Aid Section
BU-F-OSS-36 Revision No.: 2 Date of Effectivity: May 18, 2015
For Renewal STUDENT PERFORMANCE
(from the previous semester) (put N/A if you don’t have any exemplary performance(s) achieved)
Students’ Conference(s), Assembly(ies), Convention(s), & other Activities attended
General Weighted
Event Date & Venue Sponsor Average earned
Title
Competitive
Award re- Sponsor
ceived
Date
Where
Contest(s)/ Competition(s) participated When
Event Date & Venue Awards Received Work on a Program(s) accomplished

Community
Extension
Supervising Faculty
Others
(please specify)
PLEASE DONT WRITE BELOW RESERVED FOR THE OSS STAFF ONLY
The applicant has the following required documents to support his/ her application for scholarship/ financial grant/ tuition fee discount:
For FRESHMAN/ NEW APPLICANTS ITR of Parents/Certificate of tax exemption

Certificate of Registration/Pre-Assessment Form
Birth Certificate Certificate of Grades (previous semester)
BUCET Result Certification from BU HRMO
High School Report Card Certification from the BUUFA/ BUANTS
Certificate of Good Moral Character Certification/Recommendation from Dean
Certification from the Adviser
Certification from the BUIPESR (ATHLETE)
Requirements: Performing Arts Contract
Certification from the Mayor/ DILG as Certification from Benefactor
incumbent official and legitimate dependent Contract of Scholarship
Affidavit that the applicant is NOT Others:___________________________________
enjoying any other scholarship/grant(s)
C E R T I F I C A T I O N For the University Scholarship and Percentage Amount Date
This is to certify that all requirements have been complied with in Financial Grants-in-Aid Officer Discounted _____semester
accordance to BOR Resolution No.40 s 2000 that “only applications for
scholarship or enrolment with privilege with complete requirements S.Y. 20___-20____
shall be acted upon favorably by the BU OSS”.
Office of the Student Services

Scholarship and Financial Grants-in Aid Section
BU-F-OSS-36 Revision No.: 2 Date of Effectivity: May 18, 2015
BICOL UNIVERSITY
ISO 9001:2008
Certificate No. 100 05 1782

Scholarship Form (OSS-2015)

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Bicol University Legazpi City, Philippines

Application for Scholarship/ Financial Grant Acknowledgement

Scholarship/ Financial Grant being applied for: ___________________

PLEASE TAKE NOTE CAREFULLY

Date of Birth Civil Status Cellular Phone Number Email Address

High School Graduated from Date Graduated

If FRESHMAN BUCET Result High School General Average

House Number Street Barangay

Course and Year Level

Office of the Student Services

Contest(s)/ Competition(s) participated When

Event Date & Venue Awards Received Work on a Program(s) accomplished

For FRESHMAN/ NEW APPLICANTS ITR of Parents/Certificate of tax exemption

Office of the Student Services

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