CUP Financial Assistance Form

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CITY UNIVERSITY OF PASAY

(Pamantasan ng Lungsod ng Pasay)


Pasadeña street F.B Harrison, Pasay City 2 x 2 Picture

PASAY CITY GOVERNMENT STUDENT FINANCIAL ASSISTANCE


COLLEGE: ____CAS ______CBA ______COACT _____COED ____CONM
PERSONAL INFORMATION:

Name of Applicant: ____________________________________________________________________________


Surname First Name M.I
Home Address: ________________________________________________________________________________
No. Street City
Barangay: ____________ Zone: ___________ District: _______________

Course: ____________________________ Year /Section: ______________________ Gender: _________________

Student Number: _________________________ No. of units Enrolled this semester: _________

Mobile Number: __________________________ Email Address: _________________________________________


PARENT / GUARDIAN INFORMATION:

Name of Parent/Guardian: ________________________________________________________________

Home Address: _________________________________________________________________________

Contact Number: _______________________________________________________________________

CERTIFIED ENROLLED EVALUATED / ENDORSED BY:

PROF. CLEOFE T. CASTOR ___________ _________________ ____________


University Registrar Date COLLEGE DEAN DATE
Applicant is qualified for: Processed /Encoded by:

GRANT – IN – AID
Prof. Melvin M. Crisostomo ____________
Dean, Office of the Student Affairs Date
REQUIREMENTS TO SUBMIT:
_____ Barangay Certification indicating that the student and his/her parents/guardians are bonafide residents of
the City.
_____ Photocopy of parents`/guardians` Voters` Registration.
_____ Photocopy of students` (if 18 years old and above) Voter`s Registration.
_____ Photocopy of the Certificate of Matriculation /course(subjects) earned for the previous
semester (for old students only)
_____ Certification of Good Moral Character issued by the Guidance Counselor and /or Dean of the College (for old
students only) – (Note: the school Guidance Counselor will issue the Cert. of Good Moral character)

_____________________________
Applicant’s Signature

____ Semester, SY. 20__ - 20__

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