POLYTECHNIC UNIVERSITY OF THE PHILIPPINES Manila

_______________________ (Date)

The President PUP, Sta. Mesa Manila Dear Sir/Madam: I have the honor to apply for a scholarship grant in this University as: A) ACADEMIC SCHOLARSHIP /_/ /_/ /_/ /_/ /_/ /_/ /_/ /_/ /_/ /_/ B)
Valedictorian Salutatorian First Honorable Mention Resident Scholar Editor-in-Chief Top entrance examination Outstanding Achievement award Student Leader University Artist University Athlete

FINANCIAL AID GRANTS /_/ /_/ /_/ /_/ /_/ /_/ /_/ /_/ /_/ /_/ /_/ /_/ /_/
Athlete Banda Kawayan Brass Band Filipiniana Dance Troupe Maharlika Dance Troupe Polysound Rondalla Student Chorale Group Catalyst Polyrepertory Memorabilia Cadet/tee OTHERS (Special Grant)

Should my application be approved, I promise to abide by the rules, regulations, and guidelines promulgated by the Scholarship Committee, as well as that of that University, and to be a scholar worthy of the name of the University.
Very truly yours,

__________________________ (Name of Student) Course/Year/Section

POLYTECHNIC UNIVERSITY OF THE PHILIPPINES TAGUIG CAMPUS

SUMMARY OF GRADES OF THE PREVIOUS SEMESTER Semester _________________ School Year _________________ NAME ______________________________________ Year & Section _____________________ Course/Major ________________________________ DAY/NIGHT SESSION (Pls. check) Address: ______________________________________________________________________ Tel. No. _______________________________________________________________________ SUBJECT CODE PROFESSOR GRADES UNITS PRODUCTS

Total WEIGHTED AVERAGE ____________________

_______________________________ (Awardees Signature)

PRESENT SCHEDULE NAME ______________________________________ Course/Yr./Section _____________________ (Surname) (First Name) (M.I) City Address_______________________________________ Tel. No. _________________________ Permanent Address________________________________ DAY/NIGHT SESSION (Pls. check) Address: ______________________________________________________________________ Total monthly income of the family ________________________________________________ Subjects Course/Year & Sec Day Time Room

Note: Please accomplish this form and notify this office as soon as possible if there are some changes made regarding your schedule. Thank you

Republic of the Philippines Polytechnic University of the Philippines OFFICE FOR SCHOLARSHIP AND FINANCIAL ASSISTANCE Sta. Mesa, Manila FINANCIAL ASSISTANCE AGREEMENT KNOW ALL MEN BY THESE PRESENTS: This agreement, executed by ________________________________, a bona fide student of the Polytechnic University of the Philippines, hereinafter called the GRANTEE, residing at __________________________ with the written consent of ________________________________, the students PARENT/GUARDIAN residing at ______________________________________ First Part, and the Polytechnic University of the Philippines, with the principal office at Sta. Mesa, Manila, hereinafter to as Party of the Second Part. -WITNESSETHWHEREAS, the University recognizes and encourages the development and expression of talents in music, the arts and athletics and its financial assistance program is designed to support those who possess such talents; WHEREAS, the University has approved to provide the grantee a financial assistance grant consisting of /_/ full or /_/ partial tuition fees remission for the ___________ semester of 20__- 20__; WHEREFORE, the Parties of the First and Second Parts hereby agree to be bound by the following conditions: 1. That it shall the responsibility if the GRANTEE to: a) Fulfill the requirements specified in the Office Memorandum No. 2 s. 1980 and the guidelines of the organization which he is a member as certified by the head or director of the organizational concerned. b) Show exemplary conduct at all times; c) Strive to maintain excellence in his performance; d) Extend cooperation and support in the protection of implementation of the University projects, its rules and regulations, 2. That it shall be the responsibility of the UNIVERSITY to: a) Maintain the herein stipulated financial assistance grant under the aforementioned conditions; b) Cancel the financial assistance grant anytime in the basis of: 1) Misinterpretation by the GRANTEE in his/her application for financial assistance; 2) Willful violation by the GRANTEE of the rules, regulations and guidelines of the University; 3) Behavior unbecoming of a GRANTEE as determined by competent authorities if the University; or 4) Conduct inimical to the interest of the University, That the parties of this contract further agree: a) That, upon cancellation of the assistance grant, the GRANTEE shall pay the equivalent tuition fee; provided, further, that the GRANTEES grades for the semester shall be withheld until his obligation is settled; b) That the PARENT/GUARDIAN shall assist the GRANTEE in complying with the aforementioned terms and conditions. In witness whereof, we have hereunto set our hands in Manila this _____________ day of _____. By the Authority of the President:

3.

______________________ (Awardees Signature)

___________________________ Chief, OSFA ______________________ (Parent/Guardian)