Republic of the Philippines

DON HONORIO VENTURA TECHNOLOGICAL STATE UNIVERSITY

Bacolor, Pampanga

FREE TUITION 2017

PRE-REGISTRATION FORM
___ SEMESTER, ACADEMIC YEAR _____ - _____

Name of Student

________________________________ ________________________________ ________________________________

Family Name Given Name Middle Name
Contact Details

________________________________ ________________________________ ________________________________

Primary Mobile Number Secondary Mobile Number Active Email Address
Type/Classification
STUFAPs BENEFICIARY CONTINUING NEW ENROLLEE or RETURNING
Are you a beneficiary of the StuFAP? If Were you enrolled in DHVTSU in the Are you enrolling in DHVTSU for the
yes, check one: previous semester? If yes, please check first time? Were you enrolled in
the appropriate blank line AND box: DHVTSU at least once in previous
___Total annual benefit is more than semesters (but not before the current
Php 15,000, specifically amounting ___Graduating Student semester)? If yes to either of these
to Php _____________ per annum With one (1) semester remaining questions, please check the appropriate
___ Total annual benefit is less than or With one (1) academic year blank line AND box:
equal to Php 15,000, specifically remaining
amounting to Php _____________ ___Graduating Student
per annum ___Non-Graduating Student With one (1) semester remaining
Is/Was a beneficiary of 4Ps With one (1) academic year
Is included in the Listahanan 2.0 remaining
Not a beneficiary of 4Ps and not
included in the Listahanan 2.0 ___Non-Graduating Student
Is/Was a beneficiary of 4Ps
Is included in the Listahanan 2.0
Not a beneficiary of 4Ps and not
included in the Listahanan 2.0

FOR NEW ENROLLEE OR RETURNING STUDENTS ONLY

Term Last Enrolled
1st Semester 1st Trimester
2nd Semester 2nd Trimester ___________________________________________________________________________________
Summer 3rd Trimester Institution/School Last Attended/Enrolled in College

FOR NON-GRADUATING STUDENTS WHO ARE NOT BENEFICIARIES OF StuFAPs AND ARE NOT INCLUDED
IN THE 4Ps AND LISTAHANAN 2.0 MASTERLIST (to be filled out by designated college/university personnel)

______________________ ________________ ____________________________________ _______________

Most Recent Academic Standing Initials/Signature Per Capita Household Income _
Initials/Signature

I understand that the information above is true and correct and any false statement on this document, as well as on the
supporting documents, constitutes a perjury and could result in denial of the grant, and disciplinary proceedings with sanction
as per University policies.

____________________________________________ _____________________
Signature over printed name of student Date signed
Reminders: All enrolling students are required to submit the Pre-Registration Form and a photocopy of their Certificate of Registration once available.

Graduating and Non-Graduating students are required to submit the following in order for the University to assess their eligibility to Free Tuition 2017:
Original and photocopy of at least one (1) valid identification (ID) card (preferably DHVTSU ID, if applicable)
Duly accomplished Pre-Registration Form for the Free Tuition 2017
Original and photocopy of 4Ps ID card of the household member grantee, if applicable

*Additional requirement for non-graduating students who are not beneficiaries of StuFAPs and are not included in the 4Ps and Listahanan 2.0 master list:
Original and photocopy of proof of income of the household member(s) responsible in financing students cost of education

For Employed and Self-Employed Household Members: For Unemployed Household Members: For OFW Household Members:
*Annual Income Tax Return (BIR Form No. 1703), or *BIR Certificate of Exemption from Filing of ITR, and *OFW Certificate
*Certificate of Compensation Payment/Tax Withheld (BIR Form No. 2316) or *Barangay Certificate of Indigency, and *Employment Contract
*Annual Income Tax Return for Self-Employed Individuals, *Certificate of Indigency issued by DSWD
Estates, and Trusts (BIR Form No. 1701)