Republic of the Philippines

LA VERDAD CHRISTIAN COLLEGE, INC.

Apalit, Pampanga Please Attach
E-mail address: registrar@laverdad.edu.ph | info@laverdad.edu.ph RECENT FORMAL
Tel. no.: (045) 436-1487 2” x 2” picture
Facebook: www.facebook.com/laverdad.apalit WHITE BACKGROUND
with Name Tag
DO NOT WRITE ANYTHING HERE.
TO BE FILLED BY THE LVCC STAFF APPLICATION FOR with Collar
Batch No: ____
Received by: __________________
SCHOLARSHIP GRANT
Date: _______ Page ____ No. ____ S.Y. 2018 - 2019

INSTRUCTION: Write clearly in the space provided or check the box of the appropriate answer. Avoid erasures. For any erasure,
the applicant should countersign the item corrected along the page margin. PLEASE ANSWER ALL ITEMS.
I. PERSONAL DATA
1. Name of Applicant
Surname First Name Middle Name
2. Gender 3. Date of Birth 4. Place of Birth

5. Citizenship 6. Religion 7. Civil Status

8. E-mail Address: Cell Phone No.

9. Permanent Address:
No. Street Barangay City/Municipality Province Zip Code

10. Number of Children in the Family 11. Birth Order of Applicant (e.g. 1st child, 2nd child, etc.) 12. Age

13. BROTHERS/SISTERS ALSO APPLYING OR AN OLD STUDENT OF LVCC (Continue on separate sheet if necessary):
NAME: __________________________________________________ NAME: __________________________________________________
GRADE/COURSE: ________________________________________ GRADE/COURSE: ________________________________________
STATUS:  Applicant STATUS:  Applicant
 Old Student (Pls. specify  FULL  PARTIAL)  Old Student (Pls. specify  FULL  PARTIAL)

EDUCATIONAL BACKGROUND:
NAME OF SCHOOL: ________________________________________________________________________________________________
ADDRESS OF SCHOOL: _____________________________________________________________________________________________
TYPE OF SCHOOL:  PUBLIC  PRIVATE  SCIENCE
TUITION AND OTHER SCHOOL FEES PAID IN FORMER SCHOOL: P __________________________________

II. SELECT THE GRADE TO BE TAKEN IN LVCC. Please check ONE (1) box only. For SENIOR HIGH SCHOOL / COLLEGE
STUDENTS write the track or courses you want to take in LVCC on the space provided.
ELEMENTARY SENIOR HIGH SCHOOL SENIOR HIGH SCHOOL REQUIREMENTS CHECKLIST:
 Grade 1 ACADEMIC TRACK TECH-VOC TRACK (To be checked by the LVCC staff)
 Grade 2  General Academic Strand  Programming NC IV
 Grade 3  Accounting, Business & Management Strand  Health Care Services NC II  2” x 2” Recent Formal picture
 Grade 4  Humanities and Social Science Strand  Cookery NC II (White Background with Name tag)
 Grade 5  Science, Technology, Engineering and  Photocopy of report card (with
 Grade 6 Mathematics Strand LRN) at least with second grading
JUNIOR HIGH SCHOOL grades or class cards or certification
COLLEGE COLLEGE
 Grade 7 of grades.
CHED Program: TESDA Program:
 Grade 8  5-Yr Bachelor of Science in Accountancy  Mass Communication
 Photocopy of electric bills for
 Grade 9
 4-Yr Bachelor of Science in Accounting Technology previous 3 months.
 Grade 10  For Grade 11 & College
Technology  Office Management
 4-Yr Bachelor of Arts in Broadcasting  Health Care Services NC II Students: Photocopy of NCAE
SENIOR HIGH SCHOOL
 4-Yr Bachelor of Science in Social Work  Cookery NC II Result
 Grade 11
 Grade 12  4-Yr Bachelor of Science in Information System
 2-Yr Associate in Computer Technology *NOTE: When submitting this form the
applicant agrees to the following terms and
DEADLINE OF APPLICATION:
conditions:
1st Batch: Oct. 8 – Nov.12, 2016 FOR GRADE 11 AND COLLEGE STUDENTS:
2nd Batch: Nov. 14 – Dec.10, 2016 1. CREDENTIALS FILED IN
3rd Batch: Dec. 12, 2016 – Jan.14, FIRST CHOICE ___________________________________ SUPPORT OF THE APPLICATION
2017 BECOME THE PROPERTY OF THE
___ Batch: ____________________
SECOND CHOICE ___________________________________ SCHOOL AND WILL NOT BE
RETURNED TO THE APPLICANT.
THIRD CHOICE ___________________________________
2. WE DO NOT ACCEPT ORIGINAL
DOCUMENTS AND INCOMPLETE
FOR USE OF LA VERDAD CHRISTIAN COLLEGE ONLY. PLEASE DO NOT WRITE BELOW. INFORMATION AND
PRIMARY EVALUATION REQUIREMENTS.

____________________________________________________________________________________________________ I AGREE TO ALL THE ABOVE

STATEMENTS.
____________________________________________________________________________________________________
_________________________________________________
______________________________________________________ Signature over Printed name
Signature over Printed Name of Evaluator

Page 1 – LVCC : THIS FORM IS FREE OF CHARGE AND MAY BE DOWNLOADED, PRINTED OR PHOTOCOPIED.
III. FAMILY DATA
Legal Guardian
(To be accomplished ONLY by
Father Mother
those whose parents are
deceased, working abroad, etc.)
Name

Highest Educational Attainment

Religion

Contact Number/s

Occupation (pls. specify)

Name of Employer

Employer Address
Annual Income (in pesos)
(taxable and non-taxable)
If self-employed, declare gross income

IV. HOUSEHOLD INFORMATION QUESTIONNAIRE

A. Household Profile
1. Profile of household members (Please include ALL members who live under the same roof and share in common food.)
(Ibilang ang mga kasambahay o mga kamag-anak na kasalukuyang nakatira sa bahay at kasama sa inihahaing pagkain.)

Full Name Relationship to Age Civil Highest Educational Grade or Year Occupation of Gross Income for
(Put Household Head as Applicant Status Attainment Attending if Working a Year
first in the list) (Specify grade, year or Currently in Household (in pesos)
degree) School Member (8)
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
*Household head is the person who generally provides the chief source of income for the household unit. He/She is the adult person, male or female, who is
responsible for the organization and care of the household or who is regarded as such by members of the household. Continue on separate sheet if necessary.

2. Total Annual Gross Income (Total of entries in column 8) 6. Does your household own any of the following appliances, facilities and
P ______________________ vehicles?
No. of
Appliance/Vehicle
3. Do you have any relatives other than those in Household Profile Working Units
(whether here or abroad) who contribute in meeting your household _________ Air-conditioning unit
expenses? _________ Digital Camera / Video Cam / Movie Cam
 No _________ Gas/Electric Range with Oven
 Yes (How much is the average monthly contribution? P __________ ) _________ Refrigerator
_________ Computer / Laptop / Tablet / PSP / Mobile Phone
4. Electric Consumption for the Last Three Months _________ DVD Player / Stereo / Radio Component
Month: __________ __________ __________ _________ Television
Amount: __________ __________ __________ _________ Electric Fan
Note: Provide clear photocopies of the electrical bills. Provide a brief
_________ Flatiron
explanation if electric consumption is free.
_________ Washing Machine
____________________________________________________________
_________ Car/Van/Pajero/Other Similar Vehicle
5. Ownership of the housing unit: _________ Jeepney (AUV/Owner Type)
 Owned, Fully Paid  Rented (Pls. specify the amount P _________) _________ Motorcycle
 Owned, Amortized  Rent free/living w/ relatives/Inherited Other, please specify : __________________________________________
 Others, pls. specify _______________

SIGNED DECLARATION BY THE PARENTS/LEGAL GUARDIAN:

I/We hereby certify to the truthfulness and completeness of information provided. Any misinformation or withholding of information will automatically disqualify
my/our child from the LVCC Scholarship Program. In connection with this application for financial aid, I/we hereby authorize the LVCC Scholarship Committee to
conduct a credit check on the family finances, including bank accounts, credit card accounts, SSS and GSIS accounts, and to visit our family dwelling.

___________________________________ ___________________________________ ___________________________________

Applicant’s Signature Over Printed Name Father’s/Guardian’s Signature Over Printed Name Mother’s/Guardian’s Signature Over Printed Name

Page 2 - LVCC : THIS FORM IS FREE OF CHARGE AND MAY BE DOWNLOADED, PRINTED OR PHOTOCOPIED.