OFFICE OF THE MAYOR

Taguig City, Philippines Recent

2x2
ID Picture
(taken in the last 6
LIFELINE ASSISTANCE FOR NEIGHBORS’ IN-NEED months)
(L.A.N.I.) SCHOLARSHIP PROGRAM
LEAD Application Form
For RENEWING Applicants

Instruction:
1. PRINT all entries. Place an X in the appropriate blanks.
2. Be HONEST and ACCURATE with your answers. Date:___________________________________
3. FOR
CATEGORY APPLIED FOR
_____Department of Education _____ Taguig City Government
_____PNP/BJMP/BFA/AFP _____ Private School/DOST/DOH/TESDA/DOE/NFA/DOJ/NFRI/DILG
No. of Semesters that you have benefited from the LEAD Scholarship: ___

Renewing applicants must not exceed 55 years old at the time of application.
Leadership and LEAD is for those pursuing Masteral or Doctoral Degrees, who aside from being bonafide residents and voters of
Taguig, must be either an employee of a local or national government office based in Taguig OR a private school
Educators
employee of a school based also in Taguig. Their performance evaluation must not be lower than Very satisfactory,
Advancement and and the courses or specialization that they are taking must be aligned with their functions or professions. Except
Development (LEAD) for those employed by the City Government, all applicants must have been working in the city for at least 3 years
prior to the application.

REQUIREMENTS TO BE SUBMITTED
Please provide 2 (two) sets of all the documents. All photocopied documents to be submitted should be faithful reproduction of the
original. Bring the original copies of the documents for validation purposes. Ask for the 2nd set as your “Receiving Copy” upon
submission.

____ Filled-up Application Form with 2x2 ID picture (original) ____ Latest Performance Evaluation
____ Latest School Assessment or Enrolment Form ____ Curriculum Checklist of the Course Enrolled
____ Official Receipt of Enrolment ____ Workplace ID (back to back)
PERSONAL
____ INFORMATION
Certified True Copy of Grades Last Sem or last 2 terms if ____ Voter’s Certification from COMELEC
Trimester (issued by the Registrar) (Issued after the May 13, 2019 election)
____ Certificate of Good Moral (issued by the employer w/in the SY) ____ Proof of Billing in the applicant’s
____ Copy of Service Record (or his/her spouse’s) name & address

PERSONAL INFORMATION

Full Name: ____________________________________________________________________________________________________________________

(Last Name) (First Name) (Middle Name)
Address: ________________________________________________________________________________________________________________________
Cell phone No.:________________________ Other Contact No.: ___________________ E-mail Address: ______________________________
Age: _________ Gender: _______ Marital Status: _________ Citizenship: __________________ Religion: _____________________________
Date of Birth:______________________ Place of Birth: _______________________________ Years of Residency in Taguig: __________
Latest Performance Rating: (Based on the latest Performance Appraisal) _______________________________________________
For DepEd/Private School (Subject taught & Grade/Year level of students): _____________________________________________
Are you currently a recipient, or is applying to be a recipient of other scholarships grants? __________ Yes _________ No
If yes, what scholarship: _________________________________________________ Benefit per semester/trimester?: _______________
This scholarship is given by (pls. specify) ___________________________________________________________________________________

GRADUATE STUDIES INFORMATION

School Year: ___________ Semester: ____ 1stSem ____ 2ndSem______Thesis/Dissertation Grant

No. of units actually enrolledthis sem: ___________ No. of units completed last sem.: __________Year Level: ___________
Gen. Average as of Last Semester: _______ Total No. of Units Earned: ______ Are you graduating this sem? ___ Yes ___ No
Course:
School: _________________________________________________________________________________________________________________
School Address:
 EDUCATIONAL BACKGROUND

Degree Name of School / Year Honors/Awards

Obtained/Specialization School Address Graduated Received (if any)
Graduate Program
(Doctoral Degree)
Graduate Program
(Masters Degree)
Baccalaureate Program

Secondary Level
For Married Applicants:
Spouse’s Name: ________________________________ Occupation: ______________________ Gross Annual Income: _________________
Office/Institution of Employment: ____________________________________________________________________________________________
Address of Employment: _______________________________________________________________________________________________________
Name of Children: Age:
____________________ ______________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
For Unmarried Applicants:
Name of Sibling/s: Age: Civil Status: If working, where they work & income:
____________________________________________ _________ _______________ _____________________________________________________
____________________________________________ _________ _______________ _____________________________________________________
____________________________________________ _________ _______________ _____________________________________________________

ENDORSEMENT:

To: Mayor Lino Edgardo S. Cayetano

Through: Taguig City Scholarship Screening Committee
I am endorsing this applicant to the LEAD scholarship Program for the following reasons: (Please check and
sign all applicable reasons. Absence of signature in ALL of the 5 items below may be interpreted as non-
endorsement of this application.)
________1. I believe that her graduate studies will help him/her in the performance of his/her duties in this
institution/office/school;
________ 2. I believe that s/he has the capability and determination to complete his/her graduate studies;
________ 3. His/her work performance has been: _______ satisfactory ________ very satisfactory ________ outstanding;
________ 4. He/she has shown love for the City in the way s/he performs and is committed to serve in her work.
_________ 5.Other Reasons Not Mentioned (Please Specify)______________________________________________________________

I have the honor to recommend, _____________________________________________________________ (name of applicant),

_______________________________ (position), she/he has been our employee since ____________________________________________.

Endorsed by:

____________________________________________________ _____________ ___________________________________________________________

School Principal/Department Head/Agency Head DateSchool/Institution/Department/Agency/OfficeAssigned
(Signature over Printed Name)

Recommending Approval:

____________________________________________________________________________ ___________________
City Administrator/Division Superintendent/Chief of Police, Taguig City Date
******************************************************************************************************************
I hereby certify that ALL the answers given above are TRUE and CORRECT to the best of my knowledge and the attached
documents are faithful reproduction of the original copies. I recognize that ANY ACT OF DISHONESTY OR
FALSIFICATION will serve as GROUND FOR PERPETUAL DISQUALIFICATION of my application. I also understand that
this submission of application does.

__________________________________________________________
Printed Name & Signature of Applicant
Date: __________________________________________________
“Investing in Education, investing in the City’s foundation!”