Comprehensive Assistance Program for Identified Scholars (CAPIS)
SCHOLARSHIP REGISTRATION FORM
Instructions:
1. PRINT all entries. Place an X in the appropriate box.
2. Be HONEST with your answers.
3. Arrange your requirements in ____ sets.
SCHOLARSHIP PROGRAMS
Merit Scholarship
Environmental Management, Veterinary Medicine, Agriculture,
Fisheries and Forestry (EVAFF) Scholarship
Educational Financial Assistance Program (EFAP)
CHECKLIST OF REQUIREMENTS TO BE SUBMITTED
Duly accomplished application form Barangay Certificate of
with attached one (1) piece 1x1 Residency/Indigency
picture with white background
Authenticated Certificate of Live Birth
(ONCE QUALIFIED) Certified machine
copy of parents’ W2/Income Tax
Return or Original BIR Certification of
Tax Exemption. In case of deceased
parent/s, Death Certificate shall be
attached.
Certified machine copy of high school
report card or registration form, if
applicable.
1X1
PERSONAL INFORMATION
Full Name: ___________________________________________________________________
(Last Name) (First Name) (Middle Name)
Address: _____________________________________________________________________
Age: __________ Sex: ______________ Contact No.: ______________________________
Civil Status: _______________ E-Mail Address: ____________________________________
Facebook Account: __________________________________________________________
Date of Birth: _________________________ Place of Birth: __________________________
COURSE AND SCHOOL
Course: _____________________________________________ Year Level: _____________
Name of School: _____________________________________________________________
School Address: ______________________________________________________________
EDUCATIONAL BACKGROUND
SENIOR HIGH SCHOOL
Name of School: _____________________________________________________________
School Address: ______________________________________________________________
School Type: __________________Year Started – Year Graduated: ________________
JUNIOR HIGH SCHOOL
Name of School: _____________________________________________________________
School Address: ______________________________________________________________
School Type: __________________Year Started – Year Graduated: ________________
ELEMENTARY
Name of School: _____________________________________________________________
School Address: ______________________________________________________________
School Type: __________________Year Started – Year Graduated: ________________
FAMILY BACKGROUND
Father Mother Husband / Wife
( ) living ( )deceased) ( ) living ( )deceased) ( ) living ( )deceased)
Name:
Address:
Contact No.
Occupation:
Place of Work:
Highest
Educational
Attainment
I hereby certify that ALL answers given are TRUE and CORRECT to the best of my knowledge.
I further acknowledge that ANY ACT OF DISHONESTY OR FALSIFICATION MAY BE A GROUND
FOR MY DISQUALIFICATION from this scholarship program.
I also understand that this submission of application does NOT automatically qualify me for
the scholarship grant.
__________________________________ ____________________________________
Printed Name and Signature of Applicant Printed Name and Signature of Parent/Legal Guardian
__________________________________ ____________________________________
Date Date