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Application Form

The document outlines the application process for the Provincial Scholarship Program in Agusan del Sur, Philippines, which is open from May 10, 2022, to June 30, 2022, for various degree categories. Applicants must provide personal, family, and educational information, and indicate their preferred scholarship category. The form requires a signature for validation, and incomplete applications will not be accepted.

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Don Perfecto
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18 views1 page

Application Form

The document outlines the application process for the Provincial Scholarship Program in Agusan del Sur, Philippines, which is open from May 10, 2022, to June 30, 2022, for various degree categories. Applicants must provide personal, family, and educational information, and indicate their preferred scholarship category. The form requires a signature for validation, and incomplete applications will not be accepted.

Uploaded by

Don Perfecto
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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 10, 2022 to June 30, 2022
Application Form for Baccalaureate Degree &
May 10, 2022 to June 24, 2022 for
Postgraduate Studies
CATEGORY YOU WOULD LIKE TO APPLY:
(Check your preferred category below)
TRIBE:
Baccalaureate Degree: Postgraduate Studies: (Please check if you belong to any tribe
o Full Blooded IP o Masters indicated below)
o Non-IP o Doctorate o Manobo
o PWD o Law o Talaandig
o Medicine Proper o Higa-onon
o BS Nursing
o UPOU o Banwaon
Note: Please be reminded that every category has different o Other:
privileges. See the attach leaflets for every category’s entitlement. Please Specify: __________

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 countersign the item corrected along the page margin. 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*

*How did you hear about this scholarship? (Please check the box)
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.
(Please note that unsigned application form will not be accepted)

____________________________ ___________________
Signature over printed name Date

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