Place

1 x 1 Picture
Sugar Industry Foundation, Inc. Here
SIFI-EDAP Form SY 20____ - 20____
Application/Evaluation Form
College Scholarship and Assistanceship
Continuing New Course & Year :
Print all information required and file in duplicate
Date Applied : Mill/Planters' Association Affiliation :
Name of Applicant : Sex :
Last First Middle
Birth Date (MM/DD/YYYY) : Birth Place : Age :

Home Address :
So/Prk/St/Hda Brgy. Municipality/City Province
Contact Numbers : Facebook Account Name :
At least 2 Contact Numbers
School Graduated From (SHS) : Address : Year Graduated:
School Currently Enrolled In : Address :
Total Family Members : Total Family Income :
FATHER Living Deceased Monthly Income Php _____________ MOTHER Living Deceased Monthly Income Php __________
Name : :
Address : :
Occupation : :
Employer : :
Contact Number : :
Name of Dependents (Excluding single working or married brothers & sisters) Age Age

I certify that all information given on this application are true and correct to the best of my knowledge and belief.
Withholding on giving any false information will disqualify me from any scholarship grant.
Conforme: Conforme:

Parent's Signature Over Printed Name Applicant's Signature Over Printed Name

DO NOT FILL-OUT BELOW THIS LINE

(For DEDAC / SIFI Use Only) Points
Annual Per Capita Income (Php) :
General Weighted Average (Senior High School/ Semester) :
Honors/Awards Received (if any) :
Co-Curricular Activities (if any) :
Interview (for new applicants) :
Total
Documents Submitted: : BIR/Certified Income Certificate of Enrollment Report Card/Grades
Others:

Approved by:
______________________________________________
SIFI Authorized Representative

EMPLOYER'S RECOMMENDATION AND CERTIFICATION

District Educational Aid Council (DEDAC)
Sugar Industry Foundation, Inc. Date

Sir/Madam:

This is to recommend and certify that _______________________________________________________________________________

Name of Applicant
is the Son/Daughter of _____________________________________________________________________________________________ who is a
Name of Father / Mother / Guardian

Note: This is for applicants whose parents are small sugar planters / farmers

Sugarcane Planter/Farmer of ___________________________________________ Milling at __________________________________.

Name of Planters' Association Name of Sugar Mill

No. of hectare/s planted to sugarcane: _______________

Note: This is for applicants whose parents work in the sugar mill / hacienda / sugar farm / planters' association

Worker/Employee of/at ___________________________________________ Owned or Managed by ____________________________.

Name of Mill/ Sugar Farm / Hacienda / Planters' Association Farm Owner/Mill-PA Manager

Estimated annual income: Php ______________________

By: _____________________________________________________________
Signature over Printed Name of Mill/PA Authorized Representative

Designation: __________________________________________________