COLLEGE SCHOLARSHIP PROGRAM

APPLICATION FORM

(Please print)
A. PERSONAL BACKGROUND

Name: _______________________________________________________________________________________________________________
LAST NAME FIRST NAME MIDDLE NAME
Home Address: _______________________________________________________________________ Religion: ______________________
Telephone No/s. _______________________________________ Email _________________________________________________
Cellphone No. (list at least 2 numbers) __________________________________________ / _________________________________________
Date of Birth: _____________________ Age: _______________ Status: ___________ Sex: __________________
Place of Birth: ____________________ Nationality: __________ Height: __________ Weight: _______________

B. ACADEMIC BACKGROUND
Name of Public High School graduating from: ___________________________________________________ Section # _____________________
Complete address of school: ______________________________________________________________________________________________
Name of Principal ____________________________________________ Tel No/s. _______________________________________________
Latest Grade in the following subjects: MATH: __________________ ENGLISH________________ SCIENCE: _____________

Membership in Organizations in and outside of school (current year)

Organization Position Held Organization Position Held
1. 4.
2. 5.
3. 6.

Academic Awards Received at Secondary Level (3rd and 4th year level only)
Name of Award Level Name of Award Level
(e.g. National/ Regional/ (e.g. National/ Regional/ Division/
Division/ School) School)
1. 4.
2. 5.
3. 6.

(For SM Foundation use ONLY)

Total

Comments

Name of Interviewer: Company: Designation:

C. COLLEGE PLAN: (Kindly refer to the attached Guidelines for the list of schools and courses)
School/ University you plan to enroll in: Course School/ University you plan to enroll in: Course
1st Choice 2nd Choice
1. 2.

D. FAMILY BACKGROUND

Names of Family Members Age Highest Educational Last School Attended Nature of Work/ Civil Status
Attainment Name of (Single/ Married)
(e.g College Grad/ HS Company
Grad/ ES Grad
Father

Mother

Guardian:

Siblings:
1.

2.

3.

4.

5.

6.

7.

AGGREGATE INCOME OF FAMILY MEMBERS IN THE SAME HOUSEHOLD FOR ONE YEAR:

_____________________________________________________________________________ (P ________________)
(AMOUNT IN WORDS)
Note: Attach a certified list of individual incomes and their sources. _____________________________________
Signature over Printed Name of the Head of the Family

IMPORTANT: Please attach the following:

1. Photocopy of F-138 or 4th year High School Report Card with the Second or Third Grading Period’s average.
2. Photocopy of latest Income Tax Return of your parents and family members in the same household as presented above;
3. Certificate of Non-filing of Income from the BIR if exempt from filing Income Tax Return.

I certify that the above information is true and correct and that any willful misinformation and/or withholding of information will automatically disqualify
me from receiving any financial assistance from the SM Foundation, Inc.
________________________
Signature of Applicant

____________________ ___________________________
Date Today Printed Name of Applicant

*SM Foundation, Inc. retains the right to decide on the Scholarship grantees