SIFI-EDAP Form No.

1
S.Y. 2021-2022 Place
1 x 1 Picture
Sugar Industry Foundation, Inc. Here
Visayas Regional Office

Application/Evaluation Form
Continuing New College Scholarship and Assistanceship

Print all information required and file in duplicate

Date Applied : Mill/PA : Mill District :

Name of Applicant : Sex :
First Last Middle
Birth Date : Birth Place : Age :
Home Address :
So/Prk/St/Hda Brgy. Municipality/City
Contact Numbers : Facebook Account :
Atleast 3 Contact Numbers
School Graduated From : Date : Address :
School Enrolled/Intended to Enroll : Address : Course :
Total Family Members : Total Family Income :

Father Living Deceased Income P Mother Living Deceased Income P

Name : Name :
Address : Address :
Occupation : Occupation :
Employer : Employer :
Educational Attainment : Educational Attainment :

Name of Dependents Age Name of Dependents Age

(Excluding single working or married brothers & sisters) (Excluding single working or married brothers & sisters)

I certify that all information given on this application are true and correct to the best of my knowledge and belief.
Withholding on giving any false information will disqualify me from any scholarship grant.
Conforme: Conforme:

Parent's Signature Over Printed Name Applicant's Signature Over Printed Name
________________________________________________________ ___________________________
DO NOT FILL-OUT BELOW THIS LINE
(For DEDAC / SIFI Use Only) Points
Annual Per Capita Income (P) :
General Weighted Average (4th Year/SHS) :
Honors Received 1st Honor 2nd Honor with Honors
Co-Curricular Activities
Officer/Member of club/ass'n. etc. :
Member (athletics, literary, musical, cultural) :
Contestant in sports/cultural events: :
Class/Section Officer :
Interview :
Total
Documents Submitted:
BIR/Certified Income Photocopies of 4th Year /SHS Report Card NCAE Result
Medical Certificate Certificate of Co-Curricular Activities
Photo (1x1) Certificate of Good Moral
Recommended by: Approved by:

DEDAC's Signature Over Printed Name SIFI Authorized Representative

RECOMMENDATION AND CERTIFICATION

District Educational Aid Council
Sugar Industry Foundation, Inc. Date

Sir/Madam:

This is to certify that_______________________________ is the Son/Daughter of ________________________________________________

Name of Applicant Name of Father/Mother/Guardian
a Small Sugar Planter/Farmer of____________________________________ milling at _____________________________________________
(Name of Planter's Ass'n.) Name of Sugar Mill
That______________________________________________has ____ hectare/s planted to sugarcane and has a sugar production of _______
for CY ____________. .
I am recommending________________________________for scholarship to SIFI.
Name of Applicant

By:________________________________
Planter's Ass'n. Authorized Representative
Note: This form is for applicant whose parents are small sugar planter/farmer. Signature over Printed Name