REPUBLIC OF THE PHILIPPINES

PROVINCE OF ILOILO
SCHOLARSHIP SECRETARIAT
HRMDO, 3rd Floor, Iloilo Provincial Capitol, Iloilo City Tel. Nos. 3287961
ISKOLAR SANG ILOILO PROGRAM

Application No.

APPLICATION FORM
Instruction: Write clearly & legibly answers in the space provided. Check the box for the appropriate answer. Avoid erasures and answer all items.
I. PERSONAL DATA
Name of Applicant Surname First Name Middle Name
Sex Male Female Place of Birth:
Civil Status Single Married Birth Order in the Family:
Date of Birth (mm/dd/yyyy): Contact No.:
Citizenship: Email Address:
Permanent Address 1st 2nd 3rd 4th 5th

No. Street Brgy. Municipality District Province Zip Code

Are you a member of an Indigenous Community? YES NO If YES, specify:

II. EDUCATIONAL BACKGROUND SCHOOL ADDRESS

College
Course
Secondary
Senior-High School
Elementary

III. PARENTS OR LEGAL GUARDIAN Father Mother Legal Guardian

Name
Address
Occupation
Educational Attainment
No. of Siblings
No. of Household Members living under the same house

III. FAMILY SOCIO ECONOMIC DATA

Who are earning income for the family Father Mother Brother/Sister Others Specify
Source/s of Family Income Salary/Wages Farm Income Pension
Allowance Fishing Income Others Specify
Gross Monthly Family Income ₱
House Ownership Status:
Owned p Rented Living with relatives Owned,amortized/mortgaged Others Specify
No. of Appliances Owned: TV p Refrigerator Radio Electric Fan/s
Cellphones, Number of Units

______________________________________________
Signature Over Printed Name of Applicant
Conforme:
Attach recent photo here (2''x2'')

______________________________________________
Signature Over Printed Name of Parent/Legal Guardian

Date Accomplished

DO NOT FILL-OUT THIS PORTION ( FOR SECRETARIAT USE ONLY)

Documentary Requirements Application No.

( ) Properly filled out ISIP Application Form
( ) FORM 138 certified photocopy - Senior High School
( ) Certificate of no existing scholarship issued by the state college/univeristy where enrolled Received by:
( ) Photocopy of the Latest Income Tax Return or Certificate of Indigency issued by the MSWDO
Note: Applicant's Gross Annual Family Income should be ₱150,000.00 and below
( )Certificate of Residency issued by the Brgy. Captain
( ) Picture of House: inside view, outside front, outside back (you can use cellphones and print) Deadline of Submission:
( ) Vicinity Sketch of Your Residence (use landmarks) from the municipal town proper November 27, 2020

Submit the above listed documents via email to: iskolarsangiloilo.ipg@gmail.com (Subject: "ISIP APPLICATION 2020")