AFPSLAI SCHOLARSHIP and

EDUCATIONAL ASSISTANCE PROGRAM PHOTO / ID

APPLICATION FORM

A. PERSONAL BACKGROUND
NAME: ________________________________________________________________________________
LAST NAME FIRST NAME MIDDLE NAME
ADDRESS: _____________________________________________________________ ZIP CODE: _____
TELEPHONE NO/s: ____________________ E-MAIL ADDRESS: __________________________________
CELLPHONE NO/s: ____________________ AGE: ____ GENDER: ________ CIVIL STATUS: _________
DATE OF BIRTH: ___________________________ PLACE OF BIRTH: ____________________________

B. ACADEMIC BACKGROUND (Use additional sheets, if necessary)

INCLUSIVE
SCHOOL ADDRESS LEVEL DATES
(FROM/TO)

ACADEMIC HONORS / AWARDS

AWARD INSTITUTION CONFERRING AWARD DATE CONFERRED

MEMBERSHIP IN ORGANIZATIONS
INCLUSIVE
ORGANIZATION NATURE POSITION HELD DATES
(FROM/TO)

C. ACADEMIC GOALS
UNIVERSITY OR COLLEGE TO WHICH YOU HAVE APPLIED FOR ACCEPTANCE
SCHOOL DEGREE/COURSE ENTRY LEVEL

UNIVERSITY OR COLLEGE WHERE YOU HAVE BEEN ACCEPTED

SCHOOL DEGREE/COURSE ENTRY LEVEL
 SCHOLARSHIP/S WITH OTHER INSTITUTION/S
STATUS
INSTITUTION BENEFITS & PRIVILEGES
APPLYING ACCEPTED

D. FAMILY BACKGROUND
FATHER: ______________________________________________________________________________
LAST NAME FIRST NAME MIDDLE NAME
ADDRESS: _____________________________________________________________ ZIP CODE: _____
TELEPHONE NO/s: __________________________ CELLPHONE NO/s: ____________________________
DATE OF BIRTH: ___________________________ PLACE OF BIRTH: ____________________________
OCCUPATION: _____________________________ POSITION/TITLE: ____________________________

MOTHER: ______________________________________________________________________________
LAST NAME FIRST NAME MIDDLE NAME
ADDRESS: _____________________________________________________________ ZIP CODE: _____
TELEPHONE NO/s: __________________________ CELLPHONE NO/s: ____________________________
DATE OF BIRTH: ___________________________ PLACE OF BIRTH: ____________________________
OCCUPATION: _____________________________ POSITION/TITLE: ____________________________

DATE OF MARRIAGE: ________________________ PLACE OF MARRIAGE: _________________________

NAMES OF BROTHERS AND SISTERS AGE DATE OF BIRTH

Use additional sheets, if necessary.

E. SPONSOR’S INFORMATION
SPONSOR: _____________________________________________________________________________
LAST NAME FIRST NAME MIDDLE NAME
RELATIONSHIP: ______________ CIVIL STATUS: __ MARRIED __ SINGLE __ WIDOW __ SEPARATED
ADDRESS: _____________________________________________________________ ZIP CODE: _____
TELEPHONE NO/s: __________________________ CELLPHONE NO/s: ____________________________
DATE OF BIRTH: ___________________________ PLACE OF BIRTH: ____________________________

BRANCH OF SERVICE PAY JURISDICTION

( ) PNP ( ) BJMP ( ) BFP ( ) CIVILIAN ( ) GHQ ( ) PA FSU ________

( ) PCG ( ) AFPGHQ ( ) PA ( ) PAF ( ) PN ( ) PNP
( ) PN ( ) PAF ( ) Others __________ ( ) Others ________

PERSONNEL CLASSIFICATION EMPLOYMENT SERVICE

( ) MIL OFFICER ( ) MIL ENLISTED ( ) CIV REGULAR ( ) ACTIVE ( ) INACTIVE ( ) RETIRED

( ) CIV CASUAL ( ) POLICE OFFICER ( ) POLICE ENLISTED ( ) DUE TO RETIRE ( ) PENSIONER ( ) Others
( ) Others __________ ____________

BUSINESS/UNIT ADDRESS: ___________________________________ TELEPHONE NO.: ____________

DATE OF AFPSLAI MEMBERSHIP: ______________ PLACE OF TRANSACTION: ______________________
AFPSLAI MEMBERSHIP ID: ___________________ CC ACCOUNT NO.: ____________________________
SAVINGS ACCOUNT NO.: ____________________ PENSION ACCOUNT NO.: _______________________
EXISTING LOANS WITH AFPSLAI: __ SALARY/PENSION __ EMERGENCY __ BACK-TO-BACK
__ MULTI-PURPOSE __ PERSONAL __ OTHERS (specify) ________
 PLEASE ATTACH TO THIS FORM THE FOLLOWING REQUIREMENTS IN PROPER SEQUENCE:
APPLICANT’s DOCUMENTS
1. Proof of highest educational attainment such as report cards, true copy of grades/transcript of
records duly certified by the school principal/registrar
2. Copy of entrance examination result or certificate of acceptance from the school he/she is interested
to enroll in
3. Certificate of Good Moral Character from the high school principal for incoming college freshman, or
guidance counselor/college dean for incoming sophomore
4. National Statistics Office (NSO) certified Birth Certificate or in the absence thereof, certification from
the Local Civil Registry regarding the loss, destruction or absence of registry records and affidavit of
two (2) disinterested persons who have knowledge of such birth and parentage
5. Barangay or Police or NBI Clearance
6. Essay on the following:
“How will your college education improve you and your community and how will this scholarship
assist in attaining your goals?”
(Essay must be no longer than four pages, typed double spaced, written in English or Filipino)

SPONSOR’s DOCUMENTS
1. Latest payslip/Certificate of Pension (COP) and Income Tax Return (ITR) of the following:
a. if sponsor is parent, payslip/COP and ITR of both parents
b. if sponsor is sibling, payslip/COP and ITR of sponsor and both parents
2. NSO-certified Certificate of No Marriage (CENOMAR) and Affidavit of No Child, if sponsor is sibling.

IMPORTANT:
 Those with incomplete requirements will not be entertained.
 Photocopied requirements must be certified “TRUE COPY OF ORIGINAL” by receiving
branch personnel after presenting the original copies.
 AFPSLAI reserves the right to change requirements for any reason at the option of the
Association. Filling up of slots shall be subject to existing policies.

We hereby certify that all information on this form and those attached are true to
the best of my knowledge. Any misrepresentation/non-declaration of information shall
mean outright disqualification from the Program. Likewise, we authorize AFPSLAI or its
representative to verify and confirm the veracity of the information given in relation to
this application.

______________________ __________
APPLICANT’S SIGNATURE OVER DATE LEFT THUMBMARK RIGHT THUMBMARK
PRINTED NAME

______________________ __________
SPONSOR’S SIGNATURE OVER DATE LEFT THUMBMARK RIGHT THUMBMARK
PRINTED NAME