UNIVERSITY OF SANTO TOMAS

ESPAÑA, MANILA
RECENT
Office for Student Affairs ID
PICTURE
Student’s I.D. No.: Date Filed

SCHOLARSHIP APPLICATION FORM

To be filled out by the Office for Student Affairs.

 SAN MARTIN DE PORRES:  Santa Rosa de Lima  San Juan Macias  External (if applicable)_________________

INSTRUCTION:
Please PRINT legibly and fill out all areas completely. All entries will be treated confidential.
PERSONAL INFORMATION
FAMILY NAME GIVEN NAME MIDDLE NAME

LANDLINE MOBILE NUMBER E-MAIL ADDRESS GENERAL AVERAGE

(PREVIOUS TERM)

DEPARTMENT/COLLEGE/FACULTY ENROLLED ACADEMIC TRACK YEAR & SECTION

SENIOR HIGH SCHOOL
CITY ADDRESS

No. Street Barangay/Subdivision District/Municipality City Zip code

PROVINCIAL ADDRESS

No. Street Barangay/Subdivision District/Municipality City Zip code

DATE OF BIRTH AGE CIVIL STATUS RELIGION CITIZENSHIP

IN NOT LESS THAN FIVE (5) SENTENCES, WRITE SOMETHING ABOUT YOURSELF: ______________________________________________
_______________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________ __
____________________________________________________________________________________________________________________
FAMILY BACKGROUND
NAME AGE OCCUPATION

OFFICE/BUSINESS NAME & ADDRESS CONTACT NUMBER

FATHER
EMPLOYED WITH OWN BUSINESS MONTHLY INCOME
 YES  NO  Retired  Others_____________  YES  NO
NAME AGE OCCUPATION

OFFICE/BUSINESS NAME & ADDRESS CONTACT NUMBER

MOTHER
EMPLOYED WITH OWN BUSINESS MONTHLY INCOME
 YES  NO  Retired  Others_____________  YES  NO
NAME AGE COURSE/OCCUPATION SCHOOL/EMPLOYER

SIBLINGS

FAMILY FINANCIAL BACKGROUND

HOUSE TYPE HOUSE PARENT’S COMBINED ANNUAL INCOME
 Bungalow  2-storey  Others: _________  Own  Boarding House  Rent  Living with Relatives
DOES THE FAMILY OWN A VEHICLE? If YES,
 YES  NO Make Model Year

OTHER SCHOLARSHIP/GRANT BEING ENJOYED/RECEIVED: _______________________________________________________________

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 EDUCATIONAL BACKGROUND
SCHOOL NAME SCHOOL ADDRESS FROM TO HONORS/AWARDS RECEIVED
PRIMARY

SECONDARY (Junior HS)

OTHER LEARNING INSTITUTIONS

EXTRA-CURRICULAR ACTIVITIES
YEAR NAME OF CLUB/ORGANIZATION POSITION

RELATIVE/S EMPLOYED IN THE UNIVERSITY

NAME COLLEGE/FACULTY/DEPARTMENT ASSIGNED POSITION

PERSON/S TO BE CONTACTED IN CASE OF EMERGENCY: ___________________________________________________________________

ADDRESS: _____________________________________________________________________
CONTACT NO.: _________________________________________________________________

I HEREBY CERTIFY THAT ALL ABOVE-MENTIONED FACTS PROVIDED BY ME ARE TRUE AND CORRECT.
I HEREBY ALLOW UST TO VERIFY AND CONDUCT INVESTIGATION.
I UNDERSTAND THAT ANY STATEMENT PROVEN TO BE FALSE WOULD MEAN FORFEITURE OF THE GRANT GIVEN TO ME.

SIGNATURE OF THE APPLICANT

ATTACHMENTS INSTRUCTIONS
 #1 copy - 2x2 recent colored ID picture 1. PLACE all the requirements in a long brown envelope with the accomplished &
 Photocopy / Print-out of UST Entrance Test (USTET) result (must be qualified) signed application form. Arrange everything according to the list of attachments.
 Photocopy of UST Registration Form
 Photocopy of Certificate of Good Moral Character from:
2. PRINT your name / academic track / contact number / e-mail address on a sheet of
 Issued by the Junior HS Principal or Guidance Counselor (for incoming Grade 11) paper and paste at the upper right side of the envelope. (FONT size 14)
 Issued by the Senior HS Principal or the Office for Student Affairs (for Grade 11 (2nd Term) and Grade 12)
 Photocopy of
 Form 138 – Junior HS Card (for incoming Grade 11 w/ 85% Gen Ave and no grade lower than 80%) PROCEDURES FOR APPLICATION
 Temporary Transcript of Records (for students in higher grade level)
 Submit the brown envelope (following the instructions) on a scheduled date announced by the
 Photocopy of Baptismal Certificate Office of the Senior High School;
 Photocopy of Birth Certificate  Follow up your schedule from the Local Scholarship Committee of the Office of the Senior High
 Parent’s Proof of Income School for the Initial interview and Result of the Initial Interview.
 Photocopy of latest Income Tax Return of both parents; or  If qualified on the initial assessment of the Local Scholarship Committee, documents will be
 Certification of Non-filing of ITR from BIR with affidavit indicating the estimated source of annual income; or
endorsed to the Office for Student Affairs. Applicants will:
 Photocopy of Proof of Income / Pay Slip / Contract (for OFW)
 Undergo interview/s from the members of the Central Scholarship Committee, on a
 Barangay Clearance (at the back of the paper, draw a map – from the main road of your barangay scheduled date arrange by the OSA.
going to your house)
 Follow up result through a scheduled final assessment by the OSA.
 Recommendation Letter from Parish Priest

NOTE: Incomplete requirements will not be processed.

RECEIVED BY: RECEIVED BY:

_______________________________________________ DATE: _________________ _______________________________________________ DATE: _________________

(SIGNATURE OVER PRINTED NAME) (SIGNATURE OVER PRINTED NAME)

LOCAL COMMITTEE CENTRAL COMMITTEE

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