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Control No.: ___________________

ESKWELA DAVAO APPLICATION FORM

I. PERSONAL INFORMATION
Name of Beneficiary (Surname, Given Name, Suffix, MI): _______________________________
Date of Birth: _________________ Sex: ☐Male ☐Female Contact No.: _________________
Current Address:
_________________ _________________ _________________ _________________
Unit/Floor House/Bldg. Name Street No. Street Name
_________________ _________________ _________________ _________________
Barangay District City Province
Grade/Year Level: ________________ School Sector: ☐Public ☐Private
Name of School Currently Enrolled: __________________________________________________
Are you currently a beneficiary of any government educational assistance/scholarship?
☐No ☐Yes, specify _______________________________
Have you availed any government assistance/s during the COVID-19 pandemic?
☐No
☐If yes, please tick which program
☐DSWD-SAP ☐SSS-SBWS ☐DOLE-TUPAD (LGU)
☐DSWD-4Ps Beneficiary ☐DOLE-CAMP ☐DOLE-TUPAD (BKBK)

☐Others, specify _________________________

II. FAMILY BACKGROUND
Name of Family Member Sex Date of Birth Relationship to the Work
Beneficiary

III. CERTIFICATION
CERTIFICATION/AUTHORIZATION
This is to certify that all data/information that I have provided in this form are true to the best of my
knowledge. Any misinformation or withholding of information will automatically disqualify me/my beneficiary
from the program.

_________________________________ ___________________
Signature over Printed Name of Beneficiary/ Date
Authorized Person

To be filled up by Social Worker:

Remarks: ____________________________________

Assessed by:

_______________________________
Social Worker

A. Qualifications:

1. Resident of Davao City

2. Bona fide elementary student, high school, or senior high school student from any
public/private schools in Davao City
3. Has not availed any educational assistance/scholarship offered by the government

For further inquiries, please contact Commissioner Norman B. Baloro thru his contact numbers 0923-585-1995 (SMART) or 0977-193-8176 (Globe).
 4. Has not enjoyed any project/assistance/program provided by the government during this
COVID-19 Pandemic
5. Willing to enroll for the upcoming school year 2020-2021
6. Whose family income/earnings has been affected by the COVID-19 Pandemic

B. Documentary Requirements:

1. Duly accomplished Eskwela Davao Form (Downloadable & Printable)

2. Valid ID of the Family Member applying for the educational assistance (Parents or any
relatives of the student beneficiary up to the 4th civil degree of consanguinity and affinity)
3. School ID of the Student Beneficiary
4. Previous/Latest Report Card of the Student Beneficiary
5. Certificate of Eligibility from the nearest CSWDO that the family income has been
reduced/diminished due to COVID-19 Pandemic