Application Form: Surname First Name Middle Name SEX
Application Form: Surname First Name Middle Name SEX
APPLICATION FORM
RECENT
PHOTO
2x2
20 ANNUAL INCOME:
21 NAME OF MOTHER
LAST NAME FIRST NAME MIDDLE NAME 22 DATE OF BIRTH 23 CELLPHONE NO. Occupation
24 ANNUAL INCOME:
25 OTHER FAMILY MEMBERS
Name Relationship Date of Birth Name Relationship Date of Birth
1 4
2 5
3 6
(Continue on separate sheet if necessary)
ELEMENTARY
HIGH SCHOOL
COLLEGE
GRADUATE SCHOOL
I'm currently enrolled in: GRADUATE SCHOOL: YEAR:
COURSE: Regular? Yes No
27 Special Skills:
INCLUSIVE DATES
SALARY GRADE & STEP
(mm/dd/yyyy) POSITION TITLE DEPARTMENT/AGENCY/OFFICE/COMPANY MONTHLY STATUS OF GOV'T SERVICE
INCREMENT
(Write in full) (Write in full) SALARY APPOINTMENT (YES/NO)
(Format "00.0)
From To
For more inquiries call DepEd Division office of Bataan (047) 237-5222 or like us on facebook " Gurong Iskolar ng Bataan"
SCHOLARSHIP PROGRAM FOR TEACHERS
CRITERIA FOR THE SELECTION OF NOMINEES FOR THE GURONG
ISKOLAR NG BATAAN
1. With at least Very Satisfactory (VS) performance rating
2. BSE, BSED or any degree with 18 Professional Education units
3. In active service in public and private schools
4. Should enroll exclusively at BPSU
5. Is not more than 50 years old
6. Has no administrative / criminal record
7. Bonafide resident of Bataan and a registered voter
8. Physically fit, mentally healthy and register positive attitude and commitment towards
work, peers and students
9. Willing to conduct and / or assist in service training activities after scholarship
10. Did not avail any scholarship program
11. Communicative in both English and Filipino
1. Letter of Intent
2. Gurong Iskolar ng Bataan Application Form with recent 2x2 photo
3. Very Satisfactory (VS) Performance Rating for the past two (2) rating periods
4. Certified true copy of Transcript of Records (Bachelor’s Degree)
5. Certified true copy of Transcript of Records of units earned in Masteral / Doctoral Degree
6. Certificate of Employment
7. Medical Certificate issued by government physician
8. Certification from the immediate School Head that the nominee is regular in the National,
PSB, LSB or Private Schools as Pre-Elem., Elementary or Secondary Teachers
9. COMELEC I.D., Certificate of Registration
PROCEDURES:
I declare that the answers given above are true and correct and that I have not availed of
any scholarship program and shall strictly follow the guidelines, requirements and procedures
____________________________
Signature
RECOMMENDING APPROVAL:
APPROVED: