4Ps PARTY-LIST (Pagtibayin at Palaguin ang Pangkabuhayang Pilipino Party-List)

EDUCATIONAL ASSISTANCE PROGRAM

*A PRIVATE SECTOR INITIATIVE Ctrl. No.:___________

APPLICATION FORM
Write legibly.
PERSONAL INFORMATION

LAST NAME FIRST NAME MIDDLE NAME Ext.

PERMANENT ADDRESS:

STREET BRGY TOWN PROVINCE

BIRTHPLACE: MOBILE/PHONE NO.:

BIRTHDAY: CIVIL STATUS: GENDER:

FAMILY BACKGROUND
FATHER’S FULL NAME:

ADDRESS:

EDUCATIONAL ATTAINMENT: MONTHLY INCOME:

MOTHER’S FULL MAIDEN NAME:

ADDRESS:

EDUCATIONAL ATTAINMENT: MONTHLY INCOME:

ACADEMIC INFORMATION
SECONDARY SCHOOL ADDRESS:

DEGREE PROGRAM/ COURSE TAKEN:

YEAR LEVEL:

PERSONAL REFERENCES:
1.
2.
3.

I hereby certify that the foregoing statements are true and correct.
Any misinformation or withholding of information will automatically
RECENT
disqualify me from the educational assistance program. 2X2
ID PICTURE
________________________________
Applicant’s Signature over Printed Name

EVALUATED / RECOMMENDED BY: APPROVED BY:

4PS PARTY-LIST COORDINATOR

Requirements:

1. 4Ps Party-List Educational Assistance Application Form

2. Certificate of Enrollment (Photocopy)
3. Transcript of Records (from previous school year)
4. Student ID (or any government ID)
5. Barangay Clearance

Qualifications:

 Must be enrolled in the current semester.

 No failing marks from the previous semester.
(atleast no lower grades than 2.5)