OCYDO.FRM.
003
ANGAT LAHAT
ng Kabataang
CARMONA
ASSISTANCE TO CARMONA EDUCATORS AND STUDENTS (ACES)
2X2 ID PICTURE
B.T.S. (BAWAT TAHANAN MAY SCHOLAR)
APPLICATION FORM
RBI HOUSEHOLD NUMBER:
DATE
REMINDER: This educational and financial assistance program is designed to support Carmona residents who are currently
pursuing their college education, with the goal of helping them complete their studies and lessen the financial burden on
their families.
GENERAL INSTRUCTIONS:
✔
PRINT all entries. Put a ( ) in the options provided.
Be accurate in answering your form. Use CAPITAL LETTERS in answering this form.
Are you a new LGU Scholar? YES NO Do you receive any other scholarship? YES NO
lf YES, what type of Scholarship?
PERSONAL INFORMATION OF THE APPLICANT
COMPLETE NAME:
LAST NAME FIRST NAME MIDDLE NAME
COMPLETE ADDRESS:
BARANGAY: CONTACT NUMBER: EMAIL ADDRESS:
YEARS OF RESIDENCY IN CARMONA: GENDER: CIVIL STATUS: CITIZENSHIP: RELIGION:
EDUCATIONAL INFORMATION OF THE APPLICANT
COURSE: SCHOOL:
SCHOOL ADDRESS: YEAR AND SEMESTER:
SCHOOL YEAR
NAME OF SCHOOLS ATTENDED TYPE ( STARTED HONORS/AWARDS
(ELEMENTARY TO COLLEGE) PUBLIC OR SCHOOL ADDRESS AND YEAR RECEIVED (IF ANY)
PRIVATE) GRADUATED
DISCLAIMER: The City Government of Carmona, Community Affairs and Youth Development Office (CAYDO), Local Council
for the Protection of Children (LCPC), Barangay Council for the Protection of Children (BCPC), recognize its responsibilities
under the Data Privacy Act of 2012 with respect to the data that maintains both soft and hard copies. The organizers holds
and processes information for opportunities and updates for programs and projects of Local Government Unit (LGU) that
the participants may benefit.
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Dito sa Carmona, Kabataan ang Bida
OCYDO.FRM.003
FAMILY COMPOSITION OF THE APPLICANT
DATE OF CIVIL RELATION TO HIGHEST
NAME AGE SEX OCCUPATION INCOME EDUC.
BIRTH STATUS CHILD ATTAINMENT
REQUIREMENTS OF THE APPLICANT
REQUIREMENTS TO BE PREPARED AND SUBMITTED:
FILLED OUT APPLICATION FORM ORIGINAL BARANGAY CLEARANCE
PHOTOCOPY OF SCHOOL REGISTRATION FORM PERSONAL LETTER ADDRESSED TO THE CITY MAYOR
PHOTOCOPY OF ENROLLMENT RECEIPT VOTER’S CERTIFICATION OF THE APPLICANT
PHOTOCOPY OF SCHOOL ID (BACK TO BACK) 2X2 ID PICTURE TO BE ATTACHED TO THE APPLICATION
WITH 3 SPECIMEN SIGNATURE OR FORM
CERTIFICATE OF NON-ISSUANCE OF ID FROM PHOTOCOPY OF PREVIOUS GRADES
THE SCHOOL AND GOVT ISSUED ID
ORIGINAL BARANGAY INDIGENCY
I declare that all the information stated above is true and correct to the best of my knowledge, and that the documents I have
submitted are accurate copies of the original records. I understand that any form of dishonesty or falsification may lead to
my disqualification from the scholarship program.
By applying for this scholarship, I also express my full willingness to actively participate in various programs organized by
the City Government of Carmona, including but not limited to blood donation drives, clean-up activities, and other
initiatives led by the LGU and its partner agencies.
In return, I pledge my continued support for all programs and efforts of the Local Government aimed at promoting the
welfare of our community.
Signature over Printed Name of the Application Signature over Printed Name of the Parent/Guardian
DATE: DATE:
TO BE FILLED OUT BY LGU EMPLOYEES
ASSESSED AND RECEIVED BY: APPLICATION NUMBER:
DATE RECEIVED:
Signature over Printed Name of the Staff
THIS FORM CAN BE REPRODUCED BUT IS NOT FOR SALE
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