Application Form

MUNICIPAL EDUCATIONAL FINANCIAL ASSISTANCE PROGRAM

BENEFICIARY PROFILE

Part I. Personal Information ID picture taken within the

last 6 months
Name 2 x 2 (size)
Last Name/ First Name/ Middle Name Nickname Computer generated or
Xerox copy of picture is
Date of Birth Age Sex not acceptable
Registered
Address
No./St.Name/Sitio/Zone Barangay Municipality/City/Province

Present
Address
Number Street Name Sitio Barangay Municipality / City / Province
Contact
Information
Mobile Number 1 Mobile Number 2 Email Address Name of Parent's/Guardian's & Mobile Number
Educational
Information
Name of School and Branch Year Level SEM/SY: Course Major
Social Media Accts. (FB,IG & etc):
Part II. Family Background
Name of Family Relation to Age Civil Status Religion Job/ Business/ Educational Attainment
Beneficiary
Father
Mother
Husband/Wife if Applicant is Married
Siblings:

(Pls. use back page for additional items.)

Part III. Affiliation
Nature of the Activities of the
Name of organization/s you are organization/s you are organization/s you are Position/s you are holding in the organization/s
currently involved in currently involved currently involved

Please, indicate the nature of your

Please indicate the full name of your organization/s. (e.g.: SK, organization/s e.g. religious, civic, cultural, Please indicate at leaset three major activities
sports, academic, student council, student of your organization/s had conducted in the
SCAP, YFC, ROTARY, RED CROSS, BSP, GSP etc.) publication, departmental organization, past nine months.
fraternity/sororitym cummunity-based etc.

Requirements
I declare under oath that this form has been duly accomplished and is
○ Accomplished application form with 2x2 Picture true, correct and complete statement. I hereby attest myself to abide by the
○ Signed Letter of Intent addressed to the LCE rules and regulations of the Municipal Educational Financial Assistance
○ Brgy. Certificate of Indigency & Endorsement Letter Program with due respect to the organization and will immediately release
○ Certified true copy of grades
my scholarship upon reaching a demeanor as stated.
A. For Incoming Freshment
- High School Report Card __________________________________
Signature
B. For applicants with earned units in college
- Summary of Grades for the latest Semester attended signed by
the school Head/Dean/Registrar
○ Certified copy of latest registration form/enrollment form

○ Original Copy Certification of Enrollment (for those who enrolled in

other town)

This is to certify that the above-mentioned student had rendered five (5) hours of Community
Received/Processed by: service.
No.of
Name of Activity Date Place Time/Hrs. Certified by:
Rendered

Date:
(Pls. attach picture of activity)