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Application Form 2024

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51 views

Application Form 2024

Uploaded by

roshellesimbajon7
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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(Office) Education Development Services

Republic of the Philippines FB Page: PGAS- Education Development Services


PROVINCE OF AGUSAN DEL SUR Contact #: +639489658773
Governor Democrito O. Plaza Government Center, Prosperidad Email add: [email protected]

Applications will be accepted beginning


PROVINCIAL SCHOLARSHIP PROGRAM May 2, 2024 to June 14, 2024
Application Form for Baccalaureate Degree &
CATEGORY YOU WOULD LIKE TO APPLY: May 2, 2024 to July 12, 2024 for
(Check your preferred category below) Postgraduate Studies

Attach recent Baccalaureate Degree: Postgraduate Studies:


o Full Blooded IP o Masters TRIBE:
o Non-IP o Doctorate (Please check if you belong to any tribe
2’’ x 2’’ o PWD o Bachelor of Laws indicated below)
o Medicine Proper o Manobo
o BS Nursing o Talaandig
o UPOU
Photo here o MS Soil Science & o Higa-onon
Crop Protection o Banwaon
o Other:
Note: Please be reminded thatoevery category has different
Please Specify: __________
privileges. See the attach leaflets for every category’s entitlement.

I – PERSONAL INFORMATION
Instruction: Write clearly in CAPITAL LETTERS the necessary information in the box provided or check the box for the appropriate answer. Avoid
erasures. For any erasure, the applicant should affix their initial signature to the item/s corrected. PLEASE ANSWER ALL ITEMS.
PERSONAL DATA
Family Name* Given Name* Middle Name* Ext. Gender*

Address (Municipality)* Barangay* Purok* Birth Date* Age*

Birth Place* Active Facebook Account* Email* Contact No.*

GWA* (recently enrolled semester) Occupation (if applicable) Annual Income (If applicable)

Civil Status* Spouses Name Spouse’s Occupation Spouse’s Annual Income

II – FAMILY DATA
Father’s Name* Father’s Occupation* Father’s Annual Income*

Mother’s Name* Mother’s Occupation* Mother’s Annual Income*

Guardian’s Name Guardian’s Occupation Guardian’s Annual Income

III. EDUCATIONAL BACKGROUND


Reminder: If you are currently enrolled in Baccalaureate Degree & Post Grad Studies, please indicate your current year level at the time of application
in column (6).
PERIOD OF HIGHEST SCHOLARSHIP/
BASIC
NAME OF SCHOOL ATTENDANCE LEVEL/UNIT YEAR ACADEMIC
Level EDUCATION/DEGREE/COURSE
EARNED GRADUATED HONORS
(Write in full) (Write in full) From To (if not graduated) RECEIVED
(1) (2) (3) (4) (5) (6) (7) (8)

ELEMENTARY*

JUNIOR HIGH*

SENIOR HIGH*

VOCATIONAL /
TRADE COURSE*

COLLEGE*

GRADUATE
STUDIES*

IV – Preferred School and Course


If you have not yet enrolled in any Baccalaureate Degree or Postgraduate Program, kindly specify your preferred institution and desired course of
study.
School* Course*

*How did you hear about this scholarship? (Please check all that applies)
Scholarship Tarpaulin DXDA/PTV PGAS Scholars EDS Staff EDS Facebook page Others:

Pls. specify: ___________

I certify that the information provided in this form is true and correct to the best of my knowledge.

_____________________________ ___________________
Signature over printed name Date
Note: Unsigned application form will not be accepted.

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