RCDM Form No.

35 (November / 2010)

ROTARY CLUB OF DOWNTOWN MANILA

Club I.D. No. 16962, R.I. District 3810
Suite 502-503 Malate Crown Plaza, M. Adriatico cor. San Andres, Malate, Manila

Attendance No. Sponsor Copy Scholar Copy cc: Foundation Appointment No

CHARTERED 1979

RCDM CHARITABLE FOUNDATION, INC. Scholarship Periodic Disbursement Form

Date Middle Name th Month: Sex: Bachelor of: ( ) years
Grading Period

(Please Print Clearly)

: Last Name

First Name Address: Birthday: Date Place of Birth: High School: College: Completion years
Academic Period:

No. of ( Sem/Tri.

) Completed:

Year: 1 9 Phone No. Mobile No. Major in: ( ) Semester/ ( ) No.: Trimester Remaining:

( )

SUBJECTS ENROLLED
1. 2. 3. 4. 5. 6. 7. 8.

CODE

UNITS

GRADES
. . . . . . . .

Name of Sponsor:
Scholarship Grant:

P , . Periodic Amount: Peso , . Total Amount obtained before this # ___________ (

Sponsor Phone No.: No. of Installments:

Remaining Installment:

2 8

3 4 5 6 7 6 5 4

7 8 9 3 2 1

) academic period: Date

.
Verified by

3 Annual Compulsory Attendances of a Rotary Scholar:

1. 2. 3. Last Tribute to Valedictorian attended in April: Last Alay-Lakad & Mooncake Party attended in Sept.: Last Out-of-town Plant Visit & Xmas Party attended in Dec.:

Month

Noted by:
_________________________ Signature of Local Sponsor

Submitted by:
_________________________________ (Print Scholar name below signature)

Note: Please give your Sponsor a copy of this form after receiving check payment from the RCDM Foundation treasurer. For scholar with foreign sponsor, please give the Sponsor Copy to the RCDM Scholarship Committee Chairman. - (Do not fill below this line)-

Approved by :

Foundation Record Amount: P

Date : 2 0 1

Rtn. ___________________

Chairman- RCDM Scholarship Committee *** A RCDM Scholar is expected to be punctual & self-discipline- a model for others to emulate ***

Check No. :