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FORM |
Document No. |
WVSU-OSA-SOI-01-F05 |
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Revision No. |
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WEST VISAYAS STATE |
Date of Effectivity: |
July 10, 2015 |
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Issued by: |
OSA |
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UNIVERSITY |
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Page No. |
Page 1 of 2 |
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ACADEMIC SCHOLARSHIP FORM
_____ Semester, SY _____________
Date: _____________
THE PRESIDENT
This University
Sir/Madam:
May I apply for the start/continuance of my _________________________
Scholarship for the SY, ___________, ________ Semester, I have complied with all
the requirements for the said scholarship. Thank you.
Very truly yours,
_________________________
Signature over Printed Name of Scholar
_________________________
Course/Year & Section
Recommending Approval:
_________________________________
College Dean
Action Taken: ( ) Approved ( ) Disapproved
LEAH MAE C. CABALFIN, Ph. D.
Dean, OSA
PERSONAL DATA
Name of Student: _______________________Course/Year & Sec.: __________
STFAP Bracket:______Age: ______ Birth Date: ______________ Gender: ______
Contact Number: __________Complete Home Address: _____________________
__________________________________________________________________
Scholarship enjoyed the previous semester:_______________ Adviser: _________
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FORM |
Document No. |
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WVSU-OSA-SOI-01-F05 |
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Revision No. |
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WEST VISAYAS STATE |
Date of Effectivity: |
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July 10, 2015 |
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Issued by: |
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OSA |
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UNIVERSITY |
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Page No. |
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Page 2 of 2 |
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ACADEMIC DATA |
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Subject Taken (Previous |
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No. of |
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Instructor |
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Semester) |
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Units |
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GPA: ___________Total:_______ Certified Correct:_______
Adviser
CERTIFICATION
To whom it may concern:
This is to certify that _________________________________ having
obtained a GPA of _________ in the College of _______________________ for
________ semester, SY _______________. He/She is entitled to a free tuition
only for __________ semester, SY ________________ (Art.117. Sec 4,
University Code).
___________________________
Director, Admissions and Records
Note: GPA 1.5, no grade lower than 2.0