Republic of the Philippines

Province of Isabela
CITY OF CAUAYAN

CAUAYAN CITY SCHOLARSHIP PROGRAM

APPLICATION FOR SCHOLARSHIP

A.Y. 2021_ - 2026 ID Picture
_____ semester

Instructions: Fill in the required information. Put “n/a” for items not applicable to you. Submit this Form, together with the
documentary requirements, to the City Information and Communication Technology Office.

Part I. Personal Information

1. (✅ ) New ( ) Old
2. Applicants Name: ___De Castro____ __Angela______ _n/a____ _Mazo__
Last Name First Name Ext. Name (e.g. Jr.) Middle Name
3. Date of Birth: December 05, 2001 4. Sex: Female 5. Civil Status: single
6. Place of Birth: San Mateo, Isabela 7. Contact No. 09531882209 8. Citizenship: Filipino
9. Complete Address: Amobocan, Cauayan City, Isabela Purok 1, 10. Zip Code: 3305_
11. Highest Educational Attainment:
o Elementary
o High School
o College
o Others, specify ____Senior Higschol_________
12. School Last Attended: __East Asia International System College_______________
13. Report Card Average (Form 138): 87%_ 14. Awards Received: _____With Honors_____
15. Skills: _Editing, Decorating. Etc__16. Hobbies: ___Sewing clothes_________
17. Name of Father: _Bonifacio Lucero De Castro18. Occupation: ___n/a dead_____
19. Name of Mother: _Veronica De Castro____ 20. Occupation: n/a__
20. Name of the members of the Family (siblings)
▪ Bryan De Castro Age: __23______
▪ Bonifacio De Castro_ Age: _47
▪ Boniver De Castro________ Age: _35______
▪ Vanessa Balmoja_____ Age: 37_______
▪ _Venus Lejano_____ Age: ____34__
21. Gross Family Income: n/a 22. Source: N/a
23. Person to be contacted in case of emergency: __Jeffrean Abrujena___
24. Address: _Amobocan, Cauayan City___________ 25. Contact No.09367781738_
Part II. Please answer the following questions.
1. What school do you intend to enroll? _Isabela State University Angdanan Ccampus__ 2.1 Course: Bachelor of
Science Secondary Education
2. Are you willing to render voluntary community service in case the City Government needs your assistance?
•l✅Yes
No
3. Are you committed to perform well in your studies, finish your course, and behave properly?
4. ✅Yes
o No
5. Are you a beneficiary of any other scholarship grant? Y/N.
(if YES, please specify) __Wala po______________________________________________.
6. Is there any member of your family who is a recipient of the City Scholarship Program?
Wala din po
*I hereby certify that the above information is true to the best of my knowledge and belief.

Signature over Printed Name of Applicant

Form No. CIO-006-1