Application Form: Read The Instructions Carefully. All Blanks Should Be Completed. Please Print Legibly

NATIONAL HEADQUARTERS PHILIPPINE NATIONAL POLICE
PNP EDUCATIONAL ASSISTANCE BOARD

DIRECTORATE FOR PERSONNEL AND RECORDS MANAGEMENT (DPRM), Morale and Welfare Division (MWD)
Ground Floor, DPRM Annex Building, Camp BGen Rafael T Crame, Quezon City
Telephone No: 7230401 local 4253 or 4241/(02) 470-8993/ email add: mwd_dprm@yahoo.com
APPLICATION FORM
Read the instructions carefully. All blanks should be completed. Please print legibly.
INSTRUCTIONS:
1. Fill-up all entries and place NA if not applicable.
2. Attach all supporting documents in the accomplished Application Form (see requirements at the back).
3. Submit to the personnel in-charge.
INFORMATION OF APPLICANT
1. AREA: Luzon NCR Visayas Mindanao

2. NAME OF APPLICANT:
(Surname) (First Name) (Middle Name)

LATEST 2X2 PHOTO
3. RELATIONSHIP TO PNP MEMBER:
OF APPLICANT
4. CURRENT MAILING ADDRESS:
(Please write your full
City Address: name at the back of your
Phone: picture)
Provincial Address:
Phone:
Email Address: Cell Phone:
5. DATE OF BIRTH: 6. PLACE OF BIRTH:
7. SEX: Male Female 8. CIVIL STATUS: 9. RELIGION:
10. SCHOOL INTENDED TO ENROLL IN:
11. SCHOOL ADRESS:
12. EDUCATIONAL LEVEL: ELEM HS College Post-Graduate Tech/Voc Short Course
13. YEAR LEVEL: 14. COURSE:
15. HONORS RECEIVED: 16. GENERAL AVERAGE:
INFORMATION OF PNP MEMBER
1. NAME OF PNP MEMBER:
(Surname) (First Name) (M.I.) (Rank) (Unit Assignment/Region)

2. PNP STATUS:
KIA WIA TPPD DECEASED ACTIVE
3. DATE OF DEATH/TPPD:
4. PRESENT(for active) / LAST (for KIPO/TPPD/Deceased)UNIT ASSIGNMENT:
Phone: Email Address: Cellphone No:
6. DATE OF BIRTH: 7. DATE OF RETIREMENT:
8. SEX: Male Female 8. CIVIL STATUS: 9. NO OF DEPENDENTS:
NAME OF DEPENDENTS AGE YEAR LEVEL EDUCATIONAL PROGRAM AVAILED
1.
2.
3.
INFORMATION OF APPLICANT'S GUARDIAN (for KIPO)
1. NAME OF APPLICANT'S GUARDIAN
(Surname) (First Name) (M.I.) (Rank) (Unit Assignment/Region)

2. RELATIONSHIP TO APPLICANT:
City Address: Phone:
Provincial Address: Phone:
Phone: Email Address: Cellphone No:
It is understood that the information supplied above are true and correct to the best of my knowledge. Any false entry
herein shall be ground for the disqualification and/or termination of the educational benefit grant.
SIGNATURE OF APPLICANT SIGNATURE OF PNP MEMBER/GUARDIAN

(Over Printed Name) (Over Printed Name)
RECEIVED BY PNP PERSONNEL(NAME & SIGNATURE):

DATE RECEIVED:
PROGRAM:
DOCUMENTARY REQUIREMENTS
This application form shall be submitted together with the following:
For Reward Educational Assistance Program (REAP) - One-Time Grant:

1. Fully accomplished application form endorsed by their respective Chiefs of Office
2. Certificate of Declared Legal Beneficiary/ies issued by DPRM
3. Certified and authenticated photocopy of the award by issuing unit or Report by the Awards and Decorations Board
4. Authenticated Special Promotion Order for special promotion recipients
5. Two (2) copies of latest 2x2 pictures of PNP member and applicant
6. Original or authenticated copy of proof of enrollment as mandatory requirement for the release of educational assistance
grant to be submitted immediately to MWD, DPRM upon enrollment.
**7. Photocopy of Landbank of the Philippines ATM Card of the applicant (dependent)
**8. PRO/NSU Educational Assistance Board Resolution
For Dependents Educational Assistance Program (DEAP) - Annual Grant:

1. Fully accomplished application form endorsed by their respective Chiefs of Office
2. Certificate of Declared Legal Beneficiary/ies issued by DPRM
3. Authenticated copy of latest IPER (two consecutive ratings) of PNP personnel
4. Certificate of duty status and non-pending case of PNP personnel
5. Certificate of non-existing scholarship grant from any agency of the government or non-government organization,
whether local or foreign issued by respective Head of Office where a PNP member sponsor is currently assigned
6. Two (2) copies of latest 2x2 pictures of PNP member and applicant
7. Authenticated copy of proof of highest educational attainment/ good standing/acceptance, namely:
• Grade School/Elem Graduate – Form 139;
• High School (Junior and Senior) – Form 138 and diploma; and
• College Level – Report of rating.
8. Certificate of Academic Excellence Award issued by the school
9. Original or authenticated copy of proof of enrollment as mandatory requirement for the release of educational assistance
grant to be submitted immediately to MWD, DPRM upon enrollment
**10. Photocopy of Landbank of the Philippines ATM Card of the applicant (dependent)
**11. PRO/NSU Educational Assistance Board Resolution
REQUIREMENTS FOR YEARLY RENEWAL FOR EXISTING GRANTEES OF DEAP:
1. Endorsement from Unit

2.
3. Authenticated copy of latest
Original or authenticated copygrades withofGeneral
of proof Average
enrollment as mandatory requirement for the release of educational assistance
grant to be submitted immediately to MWD, DPRM upon enrollment
4. Certfificate of good moral character
5. Latest PER (Two consecutive ratings)
Note:
The documentary requirements for renewal should be submitted within 30 days upon end of the school year. Failure
to submit the said requirements shall be aground for disqualification to avail/renew the educational assistance for the
current and succeeding school years.

Application Form: Read The Instructions Carefully. All Blanks Should Be Completed. Please Print Legibly

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NATIONAL HEADQUARTERS PHILIPPINE NATIONAL POLICE

PNP EDUCATIONAL ASSISTANCE BOARD

1. AREA: Luzon NCR Visayas Mindanao

(Surname) (First Name) (Middle Name)

INFORMATION OF PNP MEMBER

1. NAME OF PNP MEMBER:

(Surname) (First Name) (M.I.) (Rank) (Unit Assignment/Region)

INFORMATION OF APPLICANT'S GUARDIAN (for KIPO)

1. NAME OF APPLICANT'S GUARDIAN

(Surname) (First Name) (M.I.) (Rank) (Unit Assignment/Region)

SIGNATURE OF APPLICANT SIGNATURE OF PNP MEMBER/GUARDIAN

RECEIVED BY PNP PERSONNEL(NAME & SIGNATURE):

For Reward Educational Assistance Program (REAP) - One-Time Grant:

For Dependents Educational Assistance Program (DEAP) - Annual Grant:

REQUIREMENTS FOR YEARLY RENEWAL FOR EXISTING GRANTEES OF DEAP:

1. Endorsement from Unit

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