REPUBLIC OF THE PHILIPPINES
PROVINCE OF LAGUNA
OFFICE OF THE GOVERNOR
Provincial Capitol Compound , Santa Cruz, Laguna
APPLICATION FORM
SCHOLARSHIP PROGRAM OF LAGUNA
2ND SEM. A.Y. 2022 - 2023
TO BE FILLED UP BY THE student
A. PERSONAL INFORMATION: Handwritten (printed) / Typewritten Slot No. 2021-01981
Name of Student DANILA, BHEA KRIZEL, ARTILLAGA
(Surname) (Given Name) (M.I.)
ROMAN
Age 22 Sex Female Status SINGLE Religion
CATHOLIC
BRGY. STA MARIA, SAN PABLO CITY,
Date of Birth 2001-12-19 Place of Birth
LAGUNA
Residential Address in
304 PUROK 5
Laguna
Province LAGUNA Municipality SAN PABLO CITY Barangay SANTA MARIA
Email
Contact No. 09483799569 bheakrizeldanila19@[Link]
Address
Contact
Name of Father DANTE CASALU DANILA Occupation FACTORY WORKER 09475644937
No.
Name of Contact
LIZA ARTILLAGA DANILA Occupation HOUSEWIFE 09515898667
Mother No.
Name of Contact
LIZA A. DANILA Relation MOTHER 09515898667
Guardian No.
Annual Family Gross
120000
Income
School Graduated Address of School Year Graduated
STA MARIA ELEMENTARY BRGY. STA MARIA, SAN
Elementary 2013
SCHOOL PABLO CITY, LAGUNA
BRGY. SANTISIMO
SANTISIMO ROSARIO
Secondary ROSARIO, SAN PABLO 2017
NATIONAL HIGH SCHOOL
CITY, LAGUNA
SANTISIMO ROSARIO BRGY. SANTISIMO
Senior High INTEGRATED HIGH ROSARIO, SAN PABLO 2019
SCHOOL CITY, LAGUNA
B. ADDITIONAL INFORMATION
Course Already
BACHELOR OF SCIENCE IN ENTREPRENEURSHIP
Enrolled
School PAMANTASAN NG LUNGSOD NG SAN PABLO
Address of School BRGY. SAN JOSE, SAN PABLO CITY, LAGUNA
Number of Units 21 Year Level 3 Graduating? NO
Expected Year of
2024 Semester N/A
Graduation
PO14S2021
Are you a recipient of any other government funded financial assistance/scholarship program?
X No
Yes (Please specify: _______________________ )
Are there any members of the family who is currently `Iskolar ng Laguna`?
X No
Yes
I hereby certify that I have read the terms and conditions governing grant as provided for by the
Scholarship Program of the Provincial Government of Laguna and its implementing rules and regulations
and hereby pledge strict observance and compliance therewith. Further, by affixing my signature, I AM
CERTIFYING THAT THE ABOVE INFORMATION IS TRUE AND CORRECT and also giving my consent to
process my personal data based on the Data Protection Policy ([Link]/opa).
With My Consent:
LIZA ARTILLAGA DANILA DANILA, BHEA KRIZEL ARTILLAGA
Signature over printed name of Parent/Guardian Signature over printed name of Student
