College Scholarship Application Form

Ateneo de Zamboanga University
1 x 1 photo
COLLEGE ADMISSIONS AND AID OFFICE ( recent )
[email protected] Telephone no. (062)9910871 local 2212
COLLEGE SCHOLARSHIP GRANT APPLICATION FORM

Please READ carefully before filling up this questionnaire
1. THIS QUESTIONNAIRE SHOULD BE ACCOMPLISHED BY THE PARENTS OR LEGAL GUARDIAN OF THE APPLICANT
2. Applicants may be called for an interview and subject to background check ( i.e. house visit ).
3. Application for a scholarship grant does not, in any way, influence admission into the university.
I - DATA ON APPLICANT
(NAME) Surname Given name Middle name Nickname
DATE OF BIRTH (month/date/year) Age Sex Religion Civil Status
COURSE 1st choice 2nd choice 3rd choice
CITY ADDRESS Telephone / Cel. No.
PROVINCIAL ADDRESS E-mail Address
JUNIOR HIGH SCHOOL ATTENDED HONORS/

AWARDS
SENOR HIGH SCHOOL ATTENDED (if transferee) College / University
HONORS/ ( specify, e.g. Valedictorian, Salutatorian, Leadership award, Proficiency award, etc. )
AWARDS
EXTRA
CURRICULAR
ACTIVITIES
II - DATA ON PARENTS / GUARDIAN

Surname Given name Middle name
FATHER
EDUCATIONAL High School College Graduate / Post Graduate
ATTAINMENT
Company / Employer Position in the firm Annual Income

OCCUPATION
JOB-RELATED Retirement / Disability ( specify amount ) Commissions / Honoraria / Allowance ( specify amount ) Other Source of Income ( indicate amount and work )
INCENTIVES
Nature of work / business Annual Income

IF SELF- EMPLOYED
MOTHER Maiden Surname Given name Middle name

ATTAINMENT
OCCUPATION
INCENTIVES
IF SELF- EMPLOYED Nature of work / business Annual Income
Surname Given name Middle name

GUARDIAN
ATTAINMENT
OCCUPATION
CITY ADDRESS
Telephone / Cel. No.
E-mail Address
PROVINCIAL ADDRESS
INCENTIVES
IF SELF- EMPLOYED Nature of work / business Annual Income

III - RELEVANT INFORMATION
1. What type of financial aid is sought?

[ ] 50% tuition only [ ] 100% tuition only [ ]100% tuition and miscellsneous fees only [ ]others ( Please specify ) ________
2. Has your child / ward applied for a scholarship grant with any other government agency or private entity / corporation?
[ ] NO [ ] YES ( Please specify ) _______________________________________________________________________
3. Without a scholarship grant, will you still enroll your child / ward ( applicant ) in the Ateneo?
[ ] NO [ ] YES ____________ __________________________________________________________________________
4. Are there any other people / relatives paying for your child / ward's ( applicant ) schooling expenses?
[ ] NO [ ] YES ______________________________________________________ ______________________________________________
5. ( for PROVINCIAL APPLICANTS only )
a. Where will your child / ward be staying for the duration of his / her studies? ______________________________________
b. How much do you expect to send for his / her board and lodging? ______________________________________________
6. Other than your child / children, who are the other dependents living with or being supported by you ( include name, age, and
relationship, and type of support ).
_______________________________________________________________________________________________________
7. Write name/s of person/s ( relatives, friends, etc. ) other than you, who help with the household and other educational
Expenses; indicate the extent of financial support ( for whom, how much ).
8. Information on children ( other than the applicant )

A. NO LONGER STUDYING
Still residing Highest educational Position in the
Civil EMPLOYMENT
NAME AGE with you? attainment ( degree & school firm or Nature Annual gross Income
status (company & location)
(YES / NO ) attended ) of work
B. STILL STUDYING ( oldest first )
Civil Grade / Year Yearly Tuition Tuition paid by whom

NAME AGE School ( Parents, relatives, etc. If a scholar, indicate type &
status Level ( amount ) amount )
9. Has any of your children been on scholarshipor financial aid at the Ateneo, or has received any form of financial aid from the
University in the past? Please indicate names and type of scholarship grant / financial aid.
10. THIS FORM SHOULD BE SUBMITTED WITH THE FOLLOWING:

A. Detailed personal statement about the need for a scholarship grant / financial aid for your son / daughter / ward
B. Clear copy of Entrance Test Result
C. Clear copy of the most recent INCOME TAX RETURNS ( of applicant's parents or guardians )
D. A copy of the applicant's Senior High School Card
E. Letter of recommendation from an Imam (for muslims), Pastor (for non-catholics) or the Parish Priest (for Catholics)
F. Detailed Sketch of your residence ( complete with house number, street, and other landmarks )
G. A copy of the applicant’s electric bills or receipts for the past 3 months
SIGNED DECLARATION BY THE APPLICANT, PARENTS / LEGAL GUARDIAN
We hereby certify that all the information given here is complete, true and correct. Any misrepresentation of information or withholding of information
requested in this questionnaire will be considered sufficient reason for cancellation of scholarship. We allow the College Admissions and Aid office to
disclose data in this questionnaire, information from the supporting documents we submitted and our child’s grade report to benefactors who will
potentially fund the scholarship of our child. We authorize the College Admissions and Aid Office to control, use and process all information we
provided in any other way necessary to pursue its legitimate interests in relation to our application for scholarship as well as keep the documents that
we have provided for historical and statistical purposes. We agree that our consent under this questionnaire shall remain valid until we deliver a
revocation in writing to the College Admissions and Aid Office.
FATHER MOTHER
( complete name and signature ) ( complete name and signature )
GUARDIAN GUARDIAN
( complete name and signature ) ( complete name and signature )

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Ateneo de Zamboanga University

COLLEGE SCHOLARSHIP GRANT APPLICATION FORM

DATE OF BIRTH (month/date/year) Age Sex Religion Civil Status

COURSE 1st choice 2nd choice 3rd choice

CITY ADDRESS Telephone / Cel. No.

PROVINCIAL ADDRESS E-mail Address

JUNIOR HIGH SCHOOL ATTENDED HONORS/

SENOR HIGH SCHOOL ATTENDED (if transferee) College / University

II - DATA ON PARENTS / GUARDIAN

Company / Employer Position in the firm Annual Income

CITY ADDRESS Telephone / Cel. No.

PROVINCIAL ADDRESS E-mail Address

Nature of work / business Annual Income

MOTHER Maiden Surname Given name Middle name

EDUCATIONAL High School College Graduate / Post Graduate

CITY ADDRESS Telephone / Cel. No.

PROVINCIAL ADDRESS E-mail Address

IF SELF- EMPLOYED Nature of work / business Annual Income

Surname Given name Middle name

IF SELF- EMPLOYED Nature of work / business Annual Income

1. What type of financial aid is sought?

8. Information on children ( other than the applicant )

B. STILL STUDYING ( oldest first )

Civil Grade / Year Yearly Tuition Tuition paid by whom

10. THIS FORM SHOULD BE SUBMITTED WITH THE FOLLOWING:

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