B i c o l U n i v e r s i t y Legazpi City, Philippines

Application for Scholarship/ Financial Grant Acknowledgement

Scholarship/ Financial Grant being applied for: ___________________

_____Semester, SY: ________
Please CHECK Internal External Government Grant

PLEASE TAKE NOTE CAREFULLY

1. Please fill up this form LEGIBLY. Please paste
2. ALL sections must be completed. your RECENT
3. Applications received after the deadline WILL NOT be considered. Passport Size
4. Please attach all ORIGINAL COPY/PHOTO COPY of requirements.
Picture Here
5. Incomplete applications WILL NOT be acted upon favorably by the Office.
6. Applications must be filed in person.

PERSONAL INFORMATION
Last Name First Name Middle Name Gender
Male Female

Date of Birth Civil Status Cellular Phone Number Email Address

CURRENT STATUS
College/ Campus Degree/ Course/Major Year Level No. of Units Enrolled Student Status
Regular
Irregular

High School Graduated from Date Graduated

If FRESHMAN BUCET Result High School General Average

FAMILY BACKGROUND
Fathers Name Occupation
Mothers Name Occupation
Annual Family Income PHP Number of Siblings in the Family
House Number Street Barangay

Home Address
Municipality Province Zip Code

House Number Street Barangay

If boarding or staying with
the Relatives Municipality Province Tel/Cellphone Number

AGREEMENT
I HEREBY CERTIFY that all information indicated in this form and on the documents attached in this application for scholarship/ financial grant/
tuition fee discount are true and correct and that any concealment or misrepresentation of facts therein found will adversely affect my application.
Signature over Printed Name Date
APPLICANT
Signature over Printed Name Date
PARENTS/ GUARDIAN
If the applicant is below 18 years old

NOTICE OF ACKNOWLEDGEMENT
Please produce three (3) photocopies of this notice
STUDENTs COPY
1 copy for the Registrar, 1 copy for the Student Affairs Coordinator, and 1 copy for the Bookkeeper

Name College/Campus
College/ Campus
Course and Year Level
Scholarship/ Financial Grant For Billing
being applied for For Tuition Fee Discount with the percentage of %
Internal Full Tuition & Other Assessed Fees
External Full Tuition Fee Discount
Government Grant or Financial Assistance Full Tuition Fee Discount with Matriculation

For Acknowledgement only

C E R T I F I C A T I O N
This is to certify that all requirements have been complied with in For the University Scholarship and Date
accordance to BOR Resolution No.40 s 2000 that only applications
Financial Grants-in-Aid Officer _____semester
for scholarship or enrolment with privilege with complete
S.Y. 20____-20_____
requirements shall be acted upon favorably by the BU OSS.

Office of the Student Services

Scholarship and Financial Grants-in-Aid Section
BU-F-OSS-36 Revision No.: 2 Date of Effectivity: May 18, 2015
For Renewal STUDENT PERFORMANCE
(from the previous semester) (put N/A if you dont have any exemplary performance(s) achieved)
Students Conference(s), Assembly(ies), Convention(s), & other Activities attended
General Weighted
Event Date & Venue Sponsor Average earned

Title
Competitive
Award re- Sponsor
ceived
Date

Where

Contest(s)/ Competition(s) participated When

Event Date & Venue Awards Received Work on a Program(s) accomplished

Community
Extension
Supervising Faculty

Others
(please specify)

PLEASE DONT WRITE BELOW RESERVED FOR THE OSS STAFF ONLY
The applicant has the following required documents to support his/ her application for scholarship/ financial grant/ tuition fee discount:

ITR of Parents/Certificate of tax exemption

For FRESHMAN/ NEW APPLICANTS
Birth Certificate
BUCET Result
High School Report Card
Certificate of Good Moral Character
Requirements:
Certification from the Mayor/ DILG as
incumbent official and legitimate dependent
Affidavit that the applicant is NOT
enjoying any other scholarship/grant(s)
C E R T I F I C A T I O N
This is to certify that all requirements have been complied with in
accordance to BOR Resolution No.40 s 2000 that only applications for
scholarship or enrolment with privilege with complete requirements
shall be acted upon favorably by the BU OSS.
Certificate of Registration/Pre-Assessment Form
Certificate of Grades (previous semester)
Certification from BU HRMO
Certification from the BUUFA/ BUANTS
Certification/Recommendation from Dean
Certification from the Adviser
Certification from the BUIPESR (ATHLETE)
Performing Arts Contract
Certification from Benefactor
Contract of Scholarship
Others:___________________________________
For the University Scholarship and Percentage Amount Date
Financial Grants-in-Aid Officer Discounted _____semester
S.Y. 20___-20____

Office of the Student Services

Scholarship and Financial Grants-in Aid Section
BU-F-OSS-36 Revision No.: 2 Date of Effectivity: May 18, 2015

BICOL UNIVERSITY
ISO 9001:2008
Certificate No. 100 05 1782