OSAS- QF- 28

Republic of the Philippines

CAVITE STATE UNIVERSITY
Don Severino delas Alas Campus
Indang, Cavite

APPLICATION FORM FOR SCHOLARSHIP

I. Personal Information: (PRINT ALL ENTRIES)

Name: EVANGELISTA , ALMA E. Age: 26 Sex: FEMALE
Address: #0070 BARANGAY SALCEDO 2, NOVELETA, CAVITE, 4105
Contact No.: 09275706212 Email Address: almaevangelista43@gmail.com
Date of Birth: 08/05/1995 Place of Birth: LAS PIÑAS CITY, METRO MANILA
Name of Father: NOT APPLICABLE Occupation: NOT APPLICABLE
Name of Mother: EMERITA E. EVANGELISTA Occupation: CARETAKER
No. of Brother/s: 1 and sister/s: 0

Name Age Year Occupation

(if in school) (if out school)
MACHAEL JOHN E. EVANGELISTA 19 HIGH SCHOOL / ALS

Estimated annual family income 180,000.00 PHP.

II. Scholarship applying for (Please check):

( ) Academic Scholarship ( ) Job Experience Program

( ) Entrance Scholarship ( ) Student Assistantship

( ) CvSU State Scholarship ( ) Service Scholarship, please specify:
( ) CvSU Scholarship Privilege ( ) Private/ Government Scholarship
( ) RA 7160 (√) Others:
Please specify: CvSU Cash Load Assistance Program

III. Reasons for Applying:

To get free cash assistance towards paying for school-related expenses especially in
prepaid load and other related internet connection services.

IV. Degree to pursue: BS CRIMINOLOGY Year & Section BSC2 -1

Major Field of Interest : N/A
Semester you are intending to enroll: 2nd Semester AY 2021-2022

V. Reference

Name Address Position/Title

LG. FE MONTEFALCON GENERAL TRIAS , CAVITE SECURITY PERSONNEL
SO. MICHAEL CONSTANTINO BACOOR, CAVITE SECURITY OFFICER
MR. MARK ACE IMO PASIG CITY, METRO MANILA OPERATION MANAGER
2022-05-25
 Attach the following REQUIREMENTS to this application form:

GENERAL REQUIREMENTS:

Scan or Portal Copy

A. Registration Form (2nd Sem, SY 2021-2022)

B. Proof of Income (any of the following):
a. Certificate of Idengency of Parent/Guardian
b. ITR of Parent/Guardian