Office of Admissions

and Scholarships
DOCUMENT CHECKLIST FORM

SECURITY BANK EXTERNAL SCHOLARSHIP PROGRAM

Name DTS
Last First Middle
College and
ID No.
Degree Program

Date/Time Submitted Received by

Instruction: Put a check () mark on the applicable documents submitted. Please arrange the scholarship application and other
documents/requirements based on the document checklist. Note: SUBMIT all scholarship application documents in a long brown envelope properly
labelled with the applicant’s complete name (SURNAME, FIRST NAME, MIDDLE INITIAL) in big upper case letters on the upper left corner on the
backside of the envelope. The Office of Admissions and Scholarships (OAS) reserves the right to decline applications that have not met the criteria
set by the Office.

 SECURITY BANK EXTERNAL Scholarship Document Others

Checklist (specify):
 Details Remarks
SBFI Scholarship Application
Form

Certificate of Graduation from

Senior High School

Certificate of Good Moral

Character from Senior High
School

Report Card/Transcript of Grade equivalent

Records from Senior High in percentage if
School indicating General grade is indicated
Weighted Average (GWA) as letter or other
values
Copy of Birth Certificate

Parent's/ Guardian's Copy of

Income Tax Return/ Certificate
of Indigency

Certificate of
Enrolment/Admission issued
by partner school

Course (Curriculum) checklist

ALL RIGHTS RESERVED 2019. Parts of this material may be reproduced provided (1) the material is not altered; (2) the use is non-commercial; (3) De La
Salle University is acknowledged as source; and (4) DLSU is notified through [email protected].
 1 X 1 ID
SCHOLARSHIP APPLICATION FORM S.Y. 2019-2020 photo
(FOR EXTERNAL PARTNER SCHOOLS) (applicant)
Please write clearly in ALL CAPITAL LETTERS. Ensure ALL FIELDS are filled-out.
APPLICATION DATE: DATE RECEIVED (PARTNER SCHOOL SCHOLARSHIP OFFICE): DATE RECEIVED (SBFI):

SCHOLARSHIP APPLICANT INFORMATION (THE STUDENT)

COMPLETE NAME:
_________________________________________________________________________________________________________________________________
Last Name First Name Middle Name Suffix
Gender: Birthday (mm/dd/yyyy): Age: Nationality: Personal Mobile #: Email address: Civil Status:

PRESENT
ADDRESS:
House No. Street / Village / Subd. Barangay City/Municipality

Province Region Country Zip Code

SCHOOLING RELATED INFORMATION
SCHOOL TO BE ENROLLED IN: TYPE OF SCHOOL (PLEASE CHECK):
Public: ______ Private: _______
SCHOOL ADDRESS:

Street/Village/Subd. Barangay City/Municipality Province Region Zip Code

YEAR LEVEL (incoming school year): HIGHEST EDUCATIONAL ATTAINMENT: LATEST GWA
(based on copy
of grades):
COURSE APPLIED FOR
MAJOR

FAMILY BACKGROUND
FATHER’S NAME (Last Name, First Name, Middle Name): MOBILE NUMBER:

AGE: NATIONALITY: OCCUPATION: COMPANY/EMPLOYER NAME: GROSS ANNUAL INCOME:

FATHER’S NAME (Last Name, First Name, Middle Name): MOBILE NUMBER:

AGE: NATIONALITY: OCCUPATION: COMPANY/EMPLOYER NAME: GROSS ANNUAL INCOME:

GROSS ANNUAL HOUSE TELEPHONE NO. OF NO. OF SIBLINGS STUDYING NO. OF SIBLINGS WITH OTHER SCHOLARSHIP (NON-SECURITY BANK)
FAMILY INCOME: NO: SIBLINGS: ____ Elementary ____ Elementary
____ High School ____ High School
____ College ____ College
DO YOU HAVE RELATIVES WORKING IN RELATIONSHIP WITH THE TENURE WITH SBC SECURITY BANK BRANCH/UNIT/DEPARTMENT/DIVISION ASSIGNED:
SECURITY BANK? Yes _____ No _______ EMPLOYEE: (YEARS):

I hereby certify that all information given are (1) accurate and true; (2) I am not a scholar of any other organization for Academic Year 2019-
2020; (3) I will abide by the decision of my school and that of Security Bank Foundation regarding my application for scholarship; and (4) any
misdeclaration shall automatically render this scholarship application null and void.

_______________________________________________________
Signature over printed name (Scholarship Applicant)
PARTNER SCHOOL ENDORSEMENT
I fully endorse the above stated application for Security Bank Foundation Scholarship Program. I certify that the above stated applicant is
admitted/enrolled/bona-fide student of our school and is eligible to apply for the scholarship.

________________________________________________________ __________________________ _____________________________________

Signature over printed name (Authorized Representative) Position College/Department/Unit
REQUIREMENTS SUBMITTED (TO BE FILLED OUT BY SECURITY BANK FOUNDATION ONLY)
CERTIFICATE OF GRADUATION (FROM SENIOR HIGH SCHOOL)
CERTIFICATE OF GOOD MORAL CHARACTER (FROM SENIOR HIGH SCHOOL)
TRANSCRIPT OF RECORDS/REPORT CARD (Equivalent of grades in percentage should be provided. Otherwise, application will be tagged as incomplete)
PHOTOCOPY OF NSO BIRTH CERTIFICATE / CERTIFIED TRUE COPY OF BIRTH CERTIFICATE
PARENT’S/GUARDIAN’S COPY OF INCOME TAX RETURN/ CERTIFICATE OF INDIGENCY
ACCEPTANCE LETTER / ENROLLMENT / REGISTRATION CARD
COURSE CURRICULUM (FOR COLLEGE LEVEL)
 SCHOLARSHIP APPLICATION
DATA PRIVACY CONSENT FORM

Dear Applicant,

Personal Data Protection Statement for Applicants

In the course of your application process with the Security Bank Foundation, Inc. (SBFI) Scholarship Program, SBFI has
collected or obtained, and will obtain or collect from time to time, personal data from you or in relation to you
(“Personal Data”). Please note that your Personal Data has been or will be collected, processed, used and stored for
purposes directly or indirectly relevant to your application for scholarship. Your Personal Data may also be used for
SBFI’s administration of scholarship and for compliance with applicable laws and regulations.

By signing and returning this Consent Form to SBFI, you confirm that you consent to the collection, use, recording,
storing, organizing, consolidation, updating, disclosure, transfer, sharing and/or general processing of your Personal
Data by SBFI as stated above and you undertake in turn to help SBFI to observe the requirements of the Data Privacy
Act of the Philippines (Republic Act No. 10173), its implementing rules and regulations and other relevant issuances
of the National Privacy Commission. The permission you are granting to SBFI shall be effective immediately and shall
continue for a period of one (1) year from the date of this consent form or until graduation from SBFI scholarship for
those who will be approved in the scholarship program (the “Permission Period”), unless you inform us in writing of
your decision to revoke your permission prior to the end of the Permission Period, in which case, SBFI shall
immediately cease from collecting, using, recording, storing, organizing, consolidation, updating, disclosure, transfer,
sharing and/or general processing of your Personal Data.

Should you have questions regarding the privacy policy you may contact our Data Privacy Officer at
_________________________.

I hereby consent to the collection, use, recording, storing, organizing, consolidation, updating, disclosure, transfer,
sharing and/or general processing of my Personal Data by SBFI in accordance with the terms of this Personal Data
Protection Statement for Applicants.

__________________________________________
Scholarship Applicant’s Signature Over Printed Name
Date: