50853114 UPbaguio Form STFAP

8/6/2019 50853114 UPbaguio Form STFAP

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THIS BOX MUST BE FILLED BY STFAP PERSONNEL ONLY THIS BOX MUST BE FILLED BY STFAPPERSONNEL ONLYSTUDENT NAME: APPLICATION FORM NO.:STUDENT NO.: [ ] [ ] - [ ] [ ] [ ] [ ] [ ] CAMPUS:

University of the PhilippinesAPPLICATION FOR FINANCIAL ASSISTANCE UNDER THE

ISKOLAR NG BAYAN(STFAP)*

To qualify for financial assistance, the student must satisfy the following:

1.The student must be a Filipino citizen.2.He must be a bonafide undergraduate student. Except for Law and Medicine, the applicant must not have abachelor's degree.

3.For an old or continuing U.P. student, who has been classified by the Universityas belonging to Brackets 1-4, hemust meet academic requirements set by the University for STFAP grantees to receive living and book subsidies.4.For an incoming freshman or new student, he must have a UP Admission slip/notice.5.The student must never have been adjudged guilty of any offense which carries apenalty of more than thirty (30) dayssuspension.6.

He must be in need of financial assistance as determined by the University.IMPORTANT NOTICE

If student is an incoming freshman, the initial grant shall be for two (2) semesters. All other grants and theirrenewals, shall be for one (1) semester only.

The University reserves the right to determine whether the student deserves financial assistance, and the kindand amount of assistance.

STFAP privileges will be withdrawn from a student who withholds and/or falsifies

information, withoutprejudice to other penalties that may be imposed by the University. In this connection, please be informedthat some students have been expelled from the University for withholding and/orfalsifying information intheir STFAP application.

All information supplied by the student will be treated with strict confidentiality and will be for internal useonly by the University.

DEADLINE FOR SUBMISSION OF APPLICATION FORMS

* Old students:* Incoming freshmen:* Transfer students from non-UP schools:



* Socialized Tuition and Financial Assistance Program1



APPLICATION FORM NO. _________

University of the PhilippinesISKOLAR NG BAYAN PROGRAM(STFAP)

APPLICATION FORM FOR FINANCIAL ASSISTANCE

To be filled out by the student and parent / legal guardian / spouse if applicant is married. Avoid erasures. For any erasure, the applicantshould countersign the item corrected along the page margin. Answer all questions. When the answer is none, write 0. When the questionis not applicable, write NA. Do not leave blanks.

Part 1. Checklist of Required Documents/Materials*

NOTE: In connection with this application, be sure to submit (where applicable)

the following documents/materials. Non-submission ofapplicable documents/materials may be considered withholding of information.

1.1 One(1) copy of 2"x2" (passport size) picture. Print name and U.P. student number at the back of the picture.1.2 Income Tax Returns (including attached BIR Form W-2, balance sheets and income statements), of parents/legal guardian/spouse. For thosewho are tax exempt, submit a certification of exemption from BIR stating the annual gross income. If parent/legal guardian/spouse is retired,submit retirement and/or pension voucher.1.2.1For first-time applicantsIncome tax returns (including all attachments) of parents/legal guardian/spousefor the last 3 years.

1.2.2For old applicantsIncome tax returns (including all attachments) of parents/ legal guardian/spousefor the current year only.1.3 Income Tax Returns of other gainfully employed members of the household forthe past year.Note: Household means all persons living under the same roof and/or sharing foodand expenses.

1.4 Affidavit of support from legal guardian, if parents are deceased or incapacitated.1.5 Personal Statement of Assets and Liabilities of parent/legal guardian/spouse. Use page 15 of this form.1.5.1Bank, housing, car or commercial loan and mortgage documents.1.5.2Affidavit concerning personal loan if value of loan declared on page 15 exceeds P10,000.1.6 Latest Tax Declarations of all real properties (required of everybody who has real property)1.7 Last month's electric bill.1.8 Last month's water bill.1.9 Business / DTI permit (if applicable).THIS BOX IS FOR USE OF UP STFAP

1.10 Marriage certificate if applicant is married. PERSONNEL ONLY

Form completely filled out?FOR INCOMING STUDENTS/FIRST-TIME APPLICANTS



1 Yes

2 No Lacks Nos. _____________ Items 1.1 to 1.10 plus:

Notarized? Office code :1 Yes 1 Yes

1. U.P. admission slip.2No 2No

2. Birth certificate or affidavit of birth.* Photocopy is required. When the student submits the documents,the originals must be presented for authentication.2



STFAP APPLICATION FORM NO __________.

_______ SEMESTER 19________ - 19________

Part 2. Application FormNOTE: Please print all entries legibly. If boxes are provided, enter only one al

phanumericcharacter per box. Encircle appropriate code for multiple choice items.

2" x 2"

2.0 Student DataPicture

Print name and student

2.1 U.P. Student No.: [ ] [ ] - [ ] [ ] [ ] [ ] [ ]number on picture and

staple here

2.2Student's Name:Family Name: _____________________________________________ First Name: _______________________________________________ Middle Name: _____________________________________________ Maiden Name (If married woman): ____________________________ 2.3 Student's Address: 1 Home 2 Dorm 3 Boarding House 4 OthersStreet Address: _________________________________________ Barangay: _____________________________________________ City/Town: ____________________________________________ Province: ______________________________________________ Zip Code: _____________

2.4 Student's Telephone Number (while at U.P.) :____________________ 2.5Parent's Address:Street Address: _________________________________________ Barangay: _____________________________________________ City/Town: ____________________________________________ Province: ______________________________________________ Zip Code: _____________ 2.6 Parent's Telephone Number: _______________________________________ 2.7Student's Permanent Address (if other than address in 2.3 or 2.5):Street Address: _________________________________________ Barangay: _____________________________________________ City/Town: ____________________________________________ Province: ______________________________________________ Zip Code: _____________ Distance (kms.) from residence to campus: ______________________ Cost of one-way transport (cheapest rate) P_____________________________________ _____ Specify: 1 Boat 2 Bus 3 Plane

2.8Date of Birth: [ ] [ ] [ ] [ ] [ ] [ ]Month Day Year



2.9 Sex (encircle appropriate code): 1 Male 2 Female3



2.10 Civil Status (encircle appropriate code):1 Single 2 Married 3 Separated/Divorced 4 Widow/Widower 5 OthersIf married: 1 living with parents/in-laws/relatives2 living independently

2.11 Do you have a brother / sister / stepbrother / stepsister / spouse enrolled

in an undergraduate college course anywhere in the U.P.System? 1 Yes 2 NoIf yes, supply the necessary information in the box below.

Name Campus College Student No.CivilStatusApplying for STFAP thissemester?Yes No

2.12 Type of financial assistance applied for (encircle only one numeric code be

low)Type of financial assistanceSTFAP BRACKET

100% waiver of tuition, miscellaneous and 1laboratory fees, plus corresponding living, 2lodging, transportation and book allowances 3

}

(subsidies)

4

100% tuition subsidy only 575% tuition subsidy only 650% tuition subsidy only 725% tuition subsidy only 8

2.13High School Data:Name of High School: _____________________________________________ Street Address: ___________________________________________________ City/Town: ______________________________________________________ Province: _______________________________________________________ Type of High School (encircle appropriate code):4 Public barrio / barangay 7 Private sectarian

1 Public general

5 U.P.-administered

8 Private non-sectarian

2 Public special (e.g., science h.s.)

6 Other state university h.s.

3 Public vocational

Tuition and other fees paid in fourth year high school P __________ / year



Were you on scholarship in high school ? 1 Yes 2 No

2.14 Are you a transferee from a non UP school ?1 Yes 2 NoIf yes, tuition and other fees paid last semester in previous college P ________ __ / semester

Were you on scholarship in previous college? 1 Yes 2 No4



2.15 College Data (encircle appropriate code):Campus:

1 Diliman 3 Los Banos

5 San Fernando 7 Tacloban/Palo

2 Manila 4 Baguio 6 Cebu 8 Iloilo/Miagao9 Mindanao

College : Year Level :Degree :

Type of Student:

1 FreshmanAY Bracket AY Bracket

2 Transferee from non-UP school

1994-95 __________ 1997-98 __________ 1995-96 __________ 1998-99 __________

3 Old Student (Old STFAP applicant)

1996-97 __________ 1999-00 __________ 4 Old Student (New STFAP applicant)

Have you been adjudged guilty of an offense and penalized for 30 days or less anywhere in the U.P. system?

1 Yes 2 No If yes, how many days? ______ Is there a pending case against you in the Student Disciplinary Tribunal or coll

ege investigating committee? 1 Yes 2 NoIf yes, what? __________________________________________________________________

Have you filed an appeal for STFAP rebracketting in previous years ? 1 Yes 2 NoHave you been visited by an STFAP Home Visit Team? 1 Yes 2 No

2.16 Do you already have a bachelor's degree? 1 Yes 2 NoIf yes, what degree did you finish ? ___________________ Year graduated ________ Name of school: __________________________________ Location of school: ________________________________

2.17 Are you staying in a boarding house or dormitory? 1 Yes 2 NoIf yes, are you staying in a U.P. dorm? 1 Yes 2 NoMonthly board P __________________ Monthly lodging P _________________

2.18 Daily mode of transport to and from school campus (encircle codes):1 Family/own vehicle2 Carpool3 Motorcycle

4 Public transport5 Bicycle/walkIf public transport, cost per day P ________



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2.19 Employment Status of Student (encircle codes):1 Full-time employment

2 Part-time employment

3 Not-employed

If you worked last year, state gross income ________ Name of company: __________________________ Address: ________________________________ Tel. No. ___________ Is this a family business or family-owned corporation? 1 Yes 2 No

2.20 Who will finance schooling (encircle all applicable codes):1 Parents

2 Self (working student)

3 Scholarship (other than STFAP)

Name of scholarship: ________________________________

Total amount of support per semester: P ____________ (including tuition, stipends, others)

4 Educational Plans (e.g. Preneed educational plan, CAP)

Name of plan: __________________________________________

Total amount of support per semester: P _____________ (including tuition, stipends, others)

5 Others (e.g. spouse, brothers, uncle)Indicate estimated amount of contribution per semester (5 months): P _______

2.21 Membership of parents or spouse in (encircle all applicable numeric codes): 0 None1 Sports and country club (e.g., Makati Sports Club, Wack Wack Golf Club)2 Service organization (e.g. Lions, Rotary)3 Professional association (e.g. Integrated Bar)4 Business organization (e.g. PCCI, Chamber of Commerce)5 Others, please specify ________________

2.22 Do you have a passport? 1 Yes 2 NoIf yes, passport # ______________ Have you ever travelled outside the Philippines within the past five years? 1 Yes 2 NoIf yes, who financed the trip? 1 Family 2 Others

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3.0FAMILY DATA3.1Parents/Legal Guardian or Spouse, if applicant is married. Are your parents separated/divorced ? 1Yes 2 NoName of Family Highest degree or School attended /

Name of employerPresent job designation (Official Job Previous Year'sIncome Taxes PaidStill AliveLivingAbroad?Member year level reached graduated Title) Gross IncomeYes No Yes NoFather / StepfatherMother /StepmotherSpouse

Legal Guardian

3.2 Brothers / Sisters / Stepbrothers / Stepsisters who are earning, including those abroadNames of Brothers / Sisterswho are earningPresent CivilStatusCurrently livingwith familyHighest degreelevel reached/School attended

graduatedName of employerPresent job designation(Official Job Title)Previous Year'sGross IncomeYesNoAbroad?Yes No

3.3Do any of your brothers/sisters/stepbrothers/stepsisters in 3.2 contribute to your family expenses ? 1 Yes 2 NoIf yes, how much is the average monthly contribution? P ________ (excluding contributions mentioned in 2.20) Who contributes ?7



Non-earning brothers / stepbrothers and sisters / stepsisters who are single andliving with the family(Note : For married applicants, include children's data whether or not they arestudying)

First Name Year of Birth

StudyingHighest Degreeor Year LevelReachedSchool Attended/ Graduatedand LocationReceving Scholarship?(other than STFAP)Amount of Scholarship (tuition,stipends, etc) per semesterYes No Yes No

3.5

What are the sources of income of the household ? (Please encircle all applicable items)1 Business 4Real estate rentals 7 Commissions2 Practice of Profession (e.g. lawyer) 5 Salaries or wages 8 Dividends/ interests/earnings from investments3 Farms/haciendas/fishponds 6 Remittances from abroad 9 Retirement pension

10Others

3.6Do you have any relatives, other than those in 3.2 (whether here or abroad), who

contribute in meeting your family expenses? 1 Yes 2 NoIf yes, how much is the average monthly contribution ? P _______/monthIf assistance is not in cash, what kind of help do they give ? _________________ _______________________ 3.7Other household members (excluding household help) not listed in 3.1, 3.2 and 3.4Annual Gross Income

Name Relationship to Student Occupation (if working)

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3.8 How many household help are living with or working for your family:NumberTotal Monthly Salary

Maid(s) _________________________ _________________________ Houseboy(s) _________________________ _________________________

Yaya(s) _________________________ _________________________ Cook(s) _________________________ _________________________ Gardener(s) _________________________ _________________________ Driver(s) _________________________ _________________________ Other(s) _________________________ _________________________

Do you have a security guard ? 1 Yes 2 No

3.9Does your family have any of the following household appliances and facilities?These include appliances which the

family owns, is amortizing or those owned by other persons or entities but are being used by the family. (DO NOTLEAVE ANY BLANKS. Write 0 if your family does not have the appliance.)N o. of working units AppliancesYear Acquired

Component stereo systemKaraokeCompact disc playerPiano/electric organ

Black and white TV

Color TVBetamax or VHS machineVideo or Movie camera (e.g. Minicamcorder)Laser Disc video/videoke

Electric/Gas/Kerosene stoveGas or Electric range with ovenMicrowave ovenRefrigeratorFreezer (upright or chest type)

Washing machineElectric clothes dryer (not spinner)Electric fanAir conditioner

Microcomputer (e.g. IBM PC compatible)Electronic game computer (e.g. SEGA)C ordless phone (not cellphone)Citizens band radio (not ordinary radio)

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3.10 Facilities installed in your house/residence1.Number of Telephone Units (land lines not cell phones): _________ Telephone Nos.: ________________ 2.Piped or running water inside house 1 Yes 2 No

Amount paid for water last monthP __________ (Attach last month's bill)3.Bathroom water heater 1 Yes 2 No4.Number of bedrooms: ________ 5.Number of toilets and/ or bathrooms: _________ Water sealed toilet 1 Yes 2 No6.Approximate total floor area of house (sq.m.) ________ 7.Electricity 1 Yes 2 No

8.Amount paid for electricity last month P _________________ (Attach last month'sbill)9.Electric Water pump/tank 1 Yes 2 No3.11Which of the following are owned by or provided to any member of the houseshold?Write 0 if none.No.ofunits No.ofunitsprovidedby

Nameofcompanyprovidingdevice

Owned officeorcompanya.Celllular/mobilephoneb.Easycall/PocketBellorsimilarmessageservice

3.12Does your family own or rent the house it is staying in? (encircle numeric code) 1Own house (not mortgaged)

2Own house (mortgaged): Monthly amortization P _________

3Renting: Monthly rental (submit receipt) P _________

4Neither own nor rent the house (submit Tax Declaration)Name of owner _______________________________________________ Relationship of owner to family __________________________________ Contributions, if any, to house owner P______________ / month

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3.13Which of the following vehicles are owned by, are being amortized or provided byother persons/entities to any member of thehousehold? Be sure to include company cars and vehicles being used by any memberof the family. Include also cars or vehiclesbeing lent by relatives or friends or owned by family business. DO NOT LEAVE BLA

NKS. Write 0 if none. It is importantto indicate the make and model year (e.g. COROLLA 1989)No. of units Year & model of all vehicles No. of units provided Year & model ofvehicles providedowned Owned (e.g. 1984 Lancer) by office or company by office or company (e.g. 1984Lancer)

a. Car or Vanb. Pajero, Trooper, LandCruiser, or similar vehiclesc. Owner-type jeep

d. Passenger jeepneye. Asian Utility vehicle(e.g Tamaraw)f. Truckg. Pick-uph. Motorcyclei. Tricyclej. Others (specify)If vehicle is provided by company,

a.Does your family own the company or stocks in the company? 1 Yes 2 Nob. Is car under a car plan? 1 Yes 2 No

If vehicle that is used by family or any member of the family is not owned by the family or any member of the family pleasestate for whom, by whom and for what purpose it is provided:For whom By whom For what purposeExample: brother United Drug used in sales / marketing

3.14Private life insurance (exclude GSIS and SSS)Parents / stepparents, spouse (if applicant is married) or guardian insured? 1 Yes 2 NoIf yes, total face value ___________Total annual premium ______________

3.15Does your family own any of the following? 1 Yes 2 NoIf yes, fill out appropriate blanksFace/Maturity ValueCertificate of time deposit P ____________________ Stocks P ____________________ Government bonds, including Treasury Bills P ____________________ Foreign currency deposits (specify currency, e.g. dollars)______________________

3.16

Does your father/stepfather / mother / stepmother / spouse (if applicant is married) or legal guardian have a credit card(s) ?1 Yes 2 No



If yes, which type(s) of credit card(s) (check all applicable)Foreign (e.g. American Express)Local bank (e.g. Bankard, BPI Express Credit, Far East Card)Local store (e.g. Shoemart)

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3.17 Real estate property owned by, or registered in the name of, family whetherfully paid or not:Residential lots:Area Location Latest Market Value(in sq. meters) ( municipality / province / city) ( as per latest Tax Declaration )

Do you earn income from these lots?Is this amount included in the Income Tax Return?11YesYes22NoNoIf yes, P __________/month

Non-residential lots/agricultural landsArea(in sq. meters)Location( municipality / province / city)Latest Market Value( as per latest Tax Declaration )

Do you earn income from these lots? 1 Yes 2 No If yes, P __________/monthIs this amount included in the Income Tax Return? 1 Yes 2 NoDo you have farm animals, agricultural machinery, motorized banca ? 1 Yes 2 No

3.18

Buildings/houses owned or rented out to others (pinauupahan) by the family (e.g.apartment, factory, shop, warehouse, etc.,including house in item 3.12)Floor Area Location Monthly Rental Charged Latest Market Value(municipality / province / (as per latest Tax

(in sq. meters)

city)Declaration)

Did you include this in the Income Tax Return ? 1 Yes 2 NoDo you have boarders/lodgers/bedspacers ? 1 Yes 2 NoIf yes,total monthly rental P

Important Note to Student and Parents or Guardian

On the basis of its evaluation, the University reserves the right to determine whether the student deserves financialassistance, and the kind and amount of assistance.

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3.19Are there special circumstances in your family which may help the University evaluate your financial need ?1 Yes 2 NoIf yes, state in the space provided below.13



4.0 VICINITY SKETCH OF RESIDENCE (to enable U.P. fact-finding team to visit residence). Please indicate landmarks.14



PERSONAL STATEMENT OF ASSETS AND LIABILITIES OFPARENTS/LEGAL GUARDIAN/SPOUSE

I, ______________________________________. of legal age, married and a residentof _______________________________

_____________________________________________________ , hereby state:

1. That my family's assets and liabilities as of December 31, 19_____, are as follows:(a) ASSETS: (Personal and Real Properties):Personal PropertiesCost

Savings P _______________ Stocks/Investments _______________ Vehicles _______________

Jewelry _______________ Furniture _______________ Appliances _______________ Others _______________

TOTAL PERSONAL PROPERTIESP _______________

Total Market Value as of

Real Properties:

latest Tax Declaration

Residential Lands P _______________ Non-residential Land/s P _______________ Residential Buildings P _______________ Non-residential Buildings P _______________

TOTAL REAL PROPERTIESP _______________

(b)LIABILITIES:* P _______________ TOTAL LIABILITIESP _______________

(c)NET WORTH: ........................................................................ P _______________ (Total Assets minus Total Liabilities)2. That this personal statement is made to support the application for financialassistance under the Iskolar ng Bayan Program(SEA) of _______________________________________ (name of student)

Printed Name and Signature of Parent/Legal Guardian/Spouse

* Note: If bank, housing, car or commercial loans, submit documents. If personalloan exceeds P 10,000, submit an affidavit.



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Part 3. STATEMENT

Statement of the Student

I hereby certify, upon my honor, that all the data and information which I havefurnished are accurate and complete.

I understand that any misinformation and / or withholding of information will automatically disqualify me from receiving anyfinancial assistance, or subsidy, and may serve as ground for my expulsion fromthe University. Furthermore, if suchmisinformation and / or withholding of information on my part is discovered after I have been awarded tuition scholarshipor any form of financial assistance, I will be required to reimburse all the financial benefits received plus all the legal rateof interest prevailing at the time of reimbursement without prejudice to the filing of charges against me.

Moreover, I authorize the University to conduct a bank credit check and send a f

act-finding team to visit my home /residence to verify the veracity of the information provided in this applicationor to obtain additional information on my capacityto pay and I will give my utmost cooperation in this regard. I understand that my refusal to comply with any of the above-mentioned conditions may mean suspension or withdrawal of STFAP benefits and privileges.

Student's Signature

Statement of the Applicant's Parent/Stepparent, Guardian or Spouse:

I hereby certify that I have read the entire questionnaire and that I certify to

the truthfulness and completeness of theinformation which my son/daughter/dependent/spouse has furnished in this application together with all the documents attached.I understand that any misinformation and / or withholding of information will automatically disqualify him / her from receivingany financial assistance, or subsidy, and may serve as ground for his / her expulsion from the University. I further recognizethat in signing this application form, I share with my son / daughter / spouse /dependent the responsibility for thetruthfulness and completeness of the information supplied herein.

Moreover, I authorize the University to conduct a bank credit check and send a fact-finding team to visit my home /residence to verify the veracity of the information provided in this applicationand I will give my utmost cooperation in this regard.I understand that my refusal to comply with any of the above-mentioned conditions may mean suspension or withdrawalof STFAP benefits and privileges of my son / daughter / dependent / spouse.

Parent's/Legal Guardian's/Spouse's Signature

Acknowledgement

REPUBLIC OF THE PHILIPPINES) S.S.

)

BEFORE ME, a Notary Public for and in the above jurisdiction, this _____________



day of ___________________,1994, personally appeared ______________________________ (name of Parent, LegalGuardian, Spouse) with CommunityTax Certificate No. __________________ issued at ____________________ on _______ ________, and ____________________________ (name of student if applicable), with Community TaxCertificate No. ____________________,

issued at ____________________________, on ________________, known to me to be same person(s) who executed theforegoing instrument and all attachments and acknowledged to me that the same istheir/his true act and deed.

IN WITNESS WHEREOF, I have hereunto set my hand and seal on the date and place herein above stated.

Doc. No. _________________ Page No. _________________ Book No. _________________ Series of 19 ________________

NOTARY PUBLICUntil December 31, 1997

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50853114 UPbaguio Form STFAP

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Transcript of 50853114 UPbaguio Form STFAP