Assisi Development Foundation Inc.
(Insert Photo
Educational Assistance Program (EAP) Here)
Application Form
TYPE OR PRINT COMPLETE ANSWERS IN THE SPACE PROVIDED FOR EACH ITEM.
1. NAME Last Name First Name Middle Name Nickname 2. Ethnicity (specify tribe)
☐PWD ☐Urban Poor ☐Rural Poor
4. Complete Date of Birth (Day/Month/Year) 5. Place of Birth (Town/City/Province)
3. Sex ☐ Male ☐Female
6. Current Home Address: 8. No of Years in Residence
7. ☐ Owned ☐ Rented ☐Living with Relatives Choose an item. For 10 up, please type: ##
Specify which relative:
9. Contact Number: 10. Email Address: 11.Facebook Name:
Complete Family Profile:
Names of Family Members Ag Educational Attainment Estimated Monthly
Relationship to Applicant Community Involvement as leader/member
Living in the same house e (Degree/Certificate) Income
# Php.000.00
# Php.000.00
# Php.000.00
# Php.000.00
# Php.000.00
Use a separate sheet to list all family members if needed. Specify income sources.
12. INCOMING SCHOOL YEAR 20 ## - 20 ## Applying for (encircle level): ☐ College Year Level Choose an item. ☐ Tech-Voc Education Choose an item.
College School Accepted/Address: Course Accepted: Entrance Score:
. ##
SHS Track: Final Grade Average: Honors/Awards/Citations Received in HS School/Parish/Civic Leadership & Membership:
(please attach report card)
##
If applying for College Year 2-4, what is your current course and year level?
Documents Required:
● For SHS completers/new applicants to College Year 1: attach SHS Form 138, course prospectus, entrance test results, birth certificate
● College Year 2-4 Applicants: Submit HS Form 137, College Certified True Copy of Grades, birth certificate
● All applicants must attach supporting documents as specified for College 1 or College 2. Late submission and incomplete information or documents can
invalidate the application.
● Submit a good reflection/written essay on: Aspirations in Life, Home, Family: Support Values and Relationships
13. Breakdown of Amount Requested (Please write the total year request)
Particulars Amount Parents’ Counterpart Amount Requested
a. Annual Tuition/Misc Fees
Attach Registration Form (RF) with assessment
of fees, subjects enrolled, course curriculum
b. Boarding House Monthly & Weekly
Allowance (identify lessor name, address,
contact)
c. Uniform & Books
(Submit official receipts. For projects, list
expenses for evaluation)
d. Daily Transportation
(submit detailed daily route and expense)
TOTAL AMOUNT Php Php Php
14. Name of Endorsing Organization, Address, Contact Information:
15. Contact Person and Contact Information:
16. I certify that I have read and understood all the questions herein; and that the information provided is true to the best of my knowledge. I understand
that any misleading statement will result in my disqualification for an educational assistance grant.
Date of Application: Applicant’s Signature: Signature of Endorsing Organization:
X X
Note: Please save this file using this format:
Page 1 of 1
EAP_RF_Abbreviated Name of Partner Inst._Name of Applicant_ Date Accomplished
