F-GTO-024

Rev01 (10-03-2016)

AFFIX
GUIDANCE AND TESTING OFFICE
PICTURE
HERE
APPLICATION FOR SCHOLARSHIP
20 to 20 ____
SCHOOL YEAR 20 ____ 21

LA PLUMA SCHOLARSHIP ENTRANCE SCHOLARSHIP ACADEMIC SCHOLARSHIP OTHERS

ELEMENTARY JUNIOR HIGH SCHOOL SENIOR HIGH SCHOOL ✔ COLLEGE LAW SCHOOL GRADUATE SCHOOL

A. PERSONAL DATA: STUDENT ID NUMBER: 19-254993

NAME: Bautista Kristelle Marisse Rogando

(Surname) (First Name) (Middle Name)

SEX: F AGE: 20 PLACE OF BIRTH: Sta. Mesa, Manila DATE OF BIRTH: April 19,2000
RELIGION: Catholic EMAIL ADDRESS: marissek19@gmail.com
PRESENT ADDRESS: Door # 3, Eight North House Rental, # 12 V. R.A. Darangan, Binangonan CONTACT NO.: 09271476223
PROVINCIAL ADDRESS: Door # 3, Eight North House Rental, # 12 V. R.A. Darangan, Binangonan Rizal CONTACT NO.: 09271476223
NATURE OF RESIDENCE: (pls. check)

PARENTS HOUSE: Owned ✔ Rented Relatives House Others: (pls. specify)

B. FAMILY BACKGROUND: (Parents/Guardians should assist the child in answering the following questions)
NAME OF FATHER: Edgardo F. Bautista AGE: 50 BIRTH DATE: February 4,1970
HIGHEST EDUCATIONAL ATTAINMENT: College RELIGION: Catholic

HOME ADDRESS: Door # 3, Eight North House Rental, # 12 V. R.A. Darangan, Binangonan CONTACT NO.: 09271476223
WORK ADDRESS: NA CONTACT NO.: NA
OCCUPATION: NA EMAIL ADDRESS: NA

NAME OF MOTHER: Emily R. Bautista AGE: 49 BIRTH DATE: February 13,1971

HIGHEST EDUCATIONAL ATTAINMENT: College RELIGION: Catholic
HOME ADDRESS: United Arabe Emirates CONTACT NO.: 09271476223

WORK ADDRESS: Dubai, United Arab Emirates CONTACT NO.: +971 4 338 7884
OCCUPATION: Senior Accountant EMAIL ADDRESS: emily@cityliner.ae

NAME OF BROTHERS/SISTERS AGE EDUCATIONAL ATTAINMENT

Katherine Ashley R. Bautista 18 Senior High School

Kristian David R. Bautista 15 Grade 9

STUDENT IS CURRENTLY LIVING WITH: (Pls. check)

Both Parents ✔ Father Only Mother Only Brother Sister

Guardian Others: (please specify)

CHECK IF YOUR PARENTS ARE:

✔ Living Together Marriage Annulled Mother with another partner
Permanently Separated Single Father Father is OFW
Temporarily Separated Single Mother ✔ Mother is OFW
Legally Separated Father with another partner

ANNUAL INCOME

50,000 – 75,000 150,001 – 200,000 300,001 - 400,000

75,001 – 100,000 200,001 – 250,000 ✔ 400,001 – 500,000
100,001 - 150,000 250,001 – 300,000 500,001 and up
C. ACADEMIC/EDUCATIONAL BACKGROUND:
LEVEL OF HONORS/ YEAR
NAME OF SCHOOL SCHOOL ADDRESS
EDUCATION ACHIEVEMENTS ATTENDED
Elementary School Genesis De Rizal School Mabuhay Homes Pnatok Binangonan, Rizal NA 2006

Junior High School Child Jesus of Prague School Batingan Binangonan, Rizal NA 2012

Senior High School Child Jesus of Prague School Batingan Binangonan, Rizal NA 2016

College Jose Rizal University Mandaluyong City NA 2018

Membership in Any Organization/Community

JRU-JPIA

D. HEALTH CONCERNS:
Do you have any medical conditions that the school should be aware of? (If yes, please be specific)
NONE

In your own handwriting tell us why are you applying for scholarship?
I'm applying for this scholarship because I want to help my parents to lessen their expenses, especially my sister will now going to college. Also this is a big motivation

for me to study hard because this is best way to help my parents not only in expenses , but also on what they want to finish my studies.

I certify that the forgoing answers are correct to the best of my knowledge. I understand that any misinterpretation will be
considered as sufficient cause for rejection of this application. Permission is herby given for any checking that may be necessary on the
answers contained herein.

KRISTELLE MARISSE R. BAUTISTA June 22, 2020 EDGARDO F. BAUTISTA

Student Signature Over Printed Name Date Accomplished Parent/Guardian Signature Over Printed Name

You are being required to submit the following documents:

Requirements for La-Pluma Scholarship (new student) Requirements for Entrance Scholarship (new student)

1. Report Card/ Certificate of Grades (photocopy) 1. Report Card/ Certificate of Grades (photocopy)
2. Certificate of Good Moral Character from the School (photocopy) 2. Certificate of Good Moral Character from the School (photocopy)
3. 1 pc 2x2 ID Picture (write your name at the back of your ID picture) 3. 2 pcs 2x2 ID Picture (write your name at the back of your ID picture)
4. Birth Certificate (photocopy) 4. Birth Certificate (photocopy)
5. Certificate of Honors stating that applicant belongs to the Top 10 of
the graduating class with total no. of graduates, official seal of school Requirements for Academic Scholarship (old student)
and signature of the principal (photocopy) 1. Copy of grades from AIMS system
2. 1 pc 2X2 ID Picture (write your name at the back of your ID picture)

DEADLINE FOR SUBMISSION

FOR JRU USE

ACTION TAKEN:
APPROVED DISAPPROVED OTHER REMARKS:

CLASSIFICATION:
LA PLUMA SCHOLARSHIP ACADEMIC A ACADEMIC B

ENTRANCE SCHOLARSHIP A ENTRANCE SCHOLARSHIP B OTHERS

LEVEL:
ES JHS SHS CO LS GS

Guidance Director Signature Over Printed Name Date

F-ACC-001
Rev01 (04-29-2014) SCF NO.: Bautista

SCHOLARSHIP FORM
INSTRUCTIONS TO APPLICANT: Fill out all the necessary information. If applying for non-government scholarship, you MUST get
department approval. Sign and date form. Please do not write in the shaded areas. Attached all the supporting documents as
applicable

STUDENT NAME: Kristelle Marisse R. Bautista I.D. NUMBER: 19-254993

SCHOOL YEAR: 2020-2021 DIVISION: ESD HSD ✔ COL LAW GSD TERM: ✔ 1 2 3 Summer

CONTACT NO.: 09564758162 GRADE/COURSE-YEAR: 3rd Year - BSA

NATURE OF SCHOLARSHIP (Please check one) SA USE PCT (%)

✔ ACADEMIC SCHOLARSHIP

La Pluma

Academic A
✔ Academic B

Academic C

ATHLETIC SCHOLARSHIP

Basketball

Volleyball

Swimming

Lawn Tennis

Track & Field

Others: (Please specify)

JRU CHORALE

STUDENT ASSISTANT

GOVERNMENT SCHOLARSHIP: (Please specify)

Others: (Please specify)

I certify that the above information is true and correct. I realize that all refunds and discounts are subject to JRU approval
and may be adjusted at any time without prior notice.

KRISTELLE MARISSE R. BAUTISTA June 22, 2020

Signature of Student/Applicant Over Printed Name Date

DIVISION/OFFICE ENDORSEMENT

APPROVED BY: DIVISION/OFFICE: DATE:

Signature Over Printed Name

FOR STUDENT ACCOUNTS SECTION USE:

VERIFIED BY: APPROVED BY: ENCODED BY:

Signature Over Printed Name Signature Over Printed Name Signature Over Printed Name
F-GTO-025
06-01-2013

GUIDANCE AND TESTING OFFICE

UNDERTAKING

I, Kristelle Marisse R. Bautista

_____________________________________________________________________, a resident of
Door # 3, Eight North House Rental, # 12 V. R.A. Darangan, Binangonan Rizal
______________________________________________________, hereby apply and seek entitlement of a
2020-2021
scholarship benefit from the Jose Rizal University for academic school year _____________. I acknowledge the
following conditions as the requisites for approval of my application:

1. The grant is subject to existing policies of the University with respect to academic scholarships,
whether written or otherwise;

2. That the grant of this benefit is now, and shall remain, the sole discretion of the University and that
grantees shall have no vested right to this benefit which they acknowledge to be the absolute right
of the University to give;

3. That whatever policies currently in governing the grant, maintenance and administration of the
scholarship program, may be modified or change by the university when and if warranted without
need of notification or consultation with the grantee, and the latter shall have no recourse against
such changes regardless of its effects;

4. That to maintain the scholarship, the grantee must fulfill conditions pertaining to grade
requirements, adherence to rules applicable to all students in respect to their enrollment and good
standing as a member of the university community.

5. That part of the scholarship requirements is the periodic need for the scholar to perform functions
that will benefit the University and its standing in the community including performing a meaningful
part in advocacies in which the University is committed.

In the event of the grant, I undertake to comply with all of the applicable provisions above; including waiving off
further entitlement to the benefit should the University see a need to terminate the program for whatever reason.
In the process, I shall hold the University free from any liability, and shall concede the right of the same to do
whatever is needed without risk of any claims or suit before the regular court.

To signify full compliance to all the above, I hereby sign this document to signify my full conformity.

CONFORME:

KRISTELLE MARISSE R. BAUTISTA JUNE 22,2020 EDGARDO F. BAUTISTA

Scholar Signature Over Printed Name Date Accomplished Parent/Guardian Signature Over Printed Name
 May 15 ,2020

Respected Sir/Ma’am,

Good day!

I, Kristelle Marisse R. Bautista writing a letter to you in order to apply for the

Academic Scholarship specifically Academic Scholarship B. Presently, I’m an incoming

third year student taking up Bachelor of Science in Accountancy. My grades in all

subjects last semester are not lowering than 2.5 therefore I got a General Percentage

Average of 1.92. I also attached the copy of my grades for both semesters for some

preferences. I apply for this scholarship because I want to help my family to lessen the

financial expenses and I don’t want to make them worry and be a reason for me not to

continue my studies. That’s why I am applying for this scholarship. Thank you and I am

hoping for your kind consideration. Have a bless day!

Sincerely,

Bautista, Kristelle Marisse R.

Lorraine R. Parangue,
ROC Director Guidance and
Testing