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Lueasp Application
Lueasp Application
I PERSONAL DATA
NAME
(Family Name) (First Name) (Middle Name)
COMPLETE POSTAL ADDRESS
II EDUCATIONAL DATA
Secondary
Business Dividends/Interest/Earnings/Investment
Retirement Pension Salary/Wages
Farms/Hacienda/Fishpond Remittance from abroad/Commission
Real estate rental Others
Practice of Profession
Does your family own or rents the house you live? Please Check.
Residential/Agricultural
Parents/Legal Guardians
School Previous
Name of Family Member Highest Degree Attended/ Present Job Gross Civil Status
/level reached Graduated Name of Employer Designation Income of Siblings
(Father)
(Mother)
(Legal Guardian)
(Brothers/Sisters)
Does your family owns any of the following household appliances and facilities? Don't leave any blank. Write O if your family does
not own the appliances:
I hereby certify that all the data and information which I have furnished are accurate and complete. I understand that any false
data given , misinterpretation and concealment of material facts and/or withholding any relevant information will automatically
disqualify me from receiving any financial assistance from the Province of La Union.
Moreover, I understand that the scholarship Committee may send a fact-finding team to visit my home/residence to verify the
veracity of the information provided in this application and will give my utmost cooperation in this regard.
Applicant's Signature
I hereby certify to the truthfulness and completeness of the information which my son/daughter/dependent has furnished in this
application together with all the documents attached. I further recognize that in signing this application form, I share with my
son/daughter/dependent the responsibility for the truthfulness and completeness of the information supplied herein.
RECOMMENDING AUTHORITY:
REMARKS