Xavier School Educational & Trust Fund, Inc.

(XSTEF)
GRANT-IN-AID APPLICATION FORM
For School Year 20____ - 20____ Recent
(1.5” x 1.5”)
Incoming Grade: _________ Photo of Student
Please check:
Please write name at
q Xavier School - San Juan the back of the photo.
q Xavier School - Nuvali

COMPLETION OF APPLICATION
All sections of the form must be answered. If any section of the form does not apply to you.
Please write “N/A” or “NOT APPLICABLE”. All given information will be kept confidential.
REJECTION OF APPLICATION
XSETF reserves the right to reject/ return GIA Application Forms that are incomplete, inaccurately
accomplished and late in submission.

Student’s Name:
LEGAL NAME LAST NAME FIRST NAME MIDDLE NAME

Current Grade & Section: Student No.:

Origin: q Regular q Child of Faculty & Staff q AFP q Proactive
Type of Application: q New q Old
q Renewal (Grantee since _________ ) (Former Grantee last _________ )
Currently Grantee (Not Recommended last _________ )
Date of Recent Home Visitation:
Name and Grade Level of other siblings in Xavier School applying for GIA:

INFORMATION ON THE GRANT

Grant Requested for Previous SY Grant Given for Current SY Grant Requested for Incoming SY
r Full Tuition r Misc. Fees r Full Tuition r Misc. Fees r Full Tuition r Misc. Fees
r ¾ Tuition r Books r ¾ Tuition r Books r ¾ Tuition r Books
r ½ Tuition r School Supplies r ½ Tuition r School Supplies r ½ Tuition r School Supplies
r ¼ Tuition r ¼ Tuition r ¼ Tuition

REASON FOR APPLYING Please check whatever is applicable:

q Our business was foreclosed (Specify nature of business, submit pertinent documents.)

q We cannot avail of our child’s educational plan. (Please specify.)

q Parents are separated and there is no support from q mother q father.

q A family member is sick and is undergoing medical treatment. (Must attach supporting documents from
the doctor) Who? Illness?
q Our income is not enough because we are sending children to school.
(Please specify how many in: Grade School High School College)
q Only one parent is working, and no one is receiving support from working children and/or relatives.
q Others (Please specify.)
 FAMILY DATA

Student Name: __________________________________________________

GUARDIAN
FATHER MOTHER
(if applicable)
Name
Age (or if deceased, when)
Date of Birth
Please indicate if:
Solo-Parent; Widowed; Separated
High School Attended
College Attended
Degree
Other studies, if any
Graduate studies
Residence Address
(indicate “ditto” if same address)
Barangay
Res. Tel. No.
Res. Fax No.
Mobile No.
E-mail Address
Name of Parish
Occupation/Profession/Business
Business/Company Name
Business/Company Address

Student No.: ______________

Office Tel. No.
Office Fax. No.
Position (current)
No. of years in present job
ANNUAL GROSS INCOME including
salary, bonuses, commissions,
differentials, overtime pay, etc.
(DO NOT LEAVE BLANK)
If self-employed, please describe
briefly, nature of work, etc.
Grade and Section: ____________
If unemployed, since when and
reason for unemployment

If retired, or ever availed of early

retirement, when and under which
company

Do you have Life Insurance? (Y/N)

If yes, since when?
Do you have Health Insurance? (Y/N)
If yes, since when?
Other Information/Comments

2
CHILDREN IN SCHOOL/ NOT YET STUDYING (Including the applicant) Please use separate sheet if needed.

Student Name: __________________________________________________

Name
Age
Civil Status
Grade/ Year Level
School
Yearly Tuition
Amount covered by Parents
Amount of Scholarship

CHILDREN NO LONGER IN SCHOOL/ WHO ARE EMPLOYED Please use separate sheet if needed.

Name
Age
Civil Status and No. of
Dependents, if applicable
Residing with the Family? (Y/N)
Educational Attainment; School
If employed, name of employer,
position and no. of years in the
company
If self-employed, nature of work
Annual Gross Income
If unemployed, since when and
reason for unemployment

SUPPORT TO OTHERS AND FROM OTHERS

FROM OTHERS

Student No.: ______________

TO OTHERS
SUPPORT (Persons assisting with family household
(Dependents living with the family)
and educational expenses)
Name
Relation to Family
If monetary, amount per monthly
Duration and extent of support
Others:

FAMILY STATUS Please check any statement that applies. Grade and Section: ____________

r Applicant lives with both parents r Applicant lives with father only
r Applicant lives with grandparents r Applicant lives with mother only
r Parents are separated, since _________ r Father is deceased
r Parents are divorced, since __________ r Mother is deceased
r Others________________________________

3
FAMILY FINANCIAL STATUS FAMILY EXPENSES

Student Name: __________________________________________________

Monthly Expenses
GROSS INCOME (in Phil Pesos)
Food/Grocery
Annual Pay, Allowance & Benefits House Rental/Amortization
Father Car Loan
Mother Electricity
Guardian Water
Commissions LPG
Profit on Business Telephone (line/prepaid)
Profit/Rental of Lands Internet (Wi-Fi)
Real Estate: Market Value Cable TV
Agricultural Land Mobile Phone (prepaid/postpaid)
Rentals on Residence/Buildings School/Work Allowance
Interest Income Support for relatives:
Transportation Allowance
Dividends (including fare and gas)
Financial Support from Children Tutorials (academic, musical, sports)
Financial Support from Relatives Helper/Driver Salary
Financial Support from Family Personal Care (beauty parlor, barber,
Association (MUST submit documents) spa, cosmetics)
Financial Support from Employer Recreational Expenses (watching
Financial Support from Others movies, dine-in, take-out, gym, etc.)
Pension (MUST submit documents) Periodicals (magazine, subscription)
Insurance Benefits Gifts (birthdays, anniversaries)
Others: Please specify.
Others: Please specify.
TOTAL ANNUAL FAMILY Subtotal of Monthly Expense
GROSS INCOME TOTAL MONTHLY EXPENSES x 12
MONTHS A)
ACCOUNTS Bank/Company Latest Balance Yearly Expenses
Current/Checking Clothing

Student No.: ______________

Savings Domestic and Foreign Travel
Time Deposit (airfare, accommodation, food, etc.)
Other Deposit Home Repair/Improvement
Foreign Currency Insurance/Medical Plans
Medical (check-up, lab fee, medicine)
Stocks/Shares
and Dental
Mutual Funds Motoring Expenses (car maintenance,
Other Types of LTO registration, car insurance)
Bonds
Tuition Fees of other children
Credit Card/s Outstanding
Bank/Company School Bus Service
(Cardholder's Name) Balance
School Supplies/Books/Uniform
SSS/GSIS, Pag-ibig, PhilHealth
(contributions)

Grade and Section: ____________

Withholding Tax
Monthly
Loan Type Bank/Company Loan Payments
Payment
Others: Please specify.
Subtotal of Yearly Expenses (B)
TOTAL ANNUAL FAMILY
EXPENSES* (Add A and B)
*If the Total Annual Family Expenses is higher than the Total Annual Family Gross Income, please explain in your letter how the deficit is covered.

Do you own/co-own a business or a home industry? q YES (If Yes, please fill out table below.) q NO
Type of Business Date Started No. of Employees Capital Invested Annual Net Profit

On the average, how much is the budgeted monthly school allowance of the student?
4
 HOUSEHOLD DATA

Student Name: __________________________________________________

PERMANENT RESIDENCE:

q House q Apartment q Condominium q Town House

Home Ownership:
q Owned q Rented (P____________ / month)
q Living with relatives/friends q Mortgaged (Bank _________________________)
q Company-owned q Others: _________________________________
When was the last renovation? How much was spent? P
2 2
Size of lot: m House floor area: m No. of floors:
No. of bedrooms: No. of toilet/bathrooms: No. of years in current residence:
Is this where the student presently resides? q Yes q No If no, please provide the current address:

OTHER PROPERTIES OWNED/ INHERITED (agricultural, residential, commercial, industrial, etc.)

Description Acquisition Present Market Yearly Net

Location Size Date Acquired
and/or use Cost Value Income

HOUSEHOLD POSSESSIONS Please do not leave blank, write N/A if it is Not Applicable.

Items Quantity Date Acquired Acquisition Cost Balance to be paid Monthly Payment
Aircon
Camera, SLR, Lenses
iPhone, Cellphone,
Smartphone

Student No.: ______________

Audio System
Gaming Consoles
(XBOX, PSP, Wii)
Home Theater System
iPad, Tablet
MacBook, Laptop, PC,
Netbook
Gas Range
Microwave, Oven
Rice Cooker
Musical Instrument
DVD, CD Player, Ipod

Grade and Section: ____________

Dock
Digital Media Players
(iPod, MP3, etc.)
Printer, Scanner
Refrigerator, Freezer
Flat Screen TV
Washing Machine, Dryer
Vacuum Cleaner, Floor
Polisher
Flat Iron, Steam Iron
Blender, Juicer
Bicycle, Kid Trike, Skate
Board, Hoverboard

5
MEMBERSHIP

Student Name: __________________________________________________

Are you affiliated or a member of any membership shopping clubs, country clubs, golf clubs, etc.?
q Yes (Please specify) q No

VEHICLES Please list any motorized vehicles owned or regularly used by the family.
(Cars, SUV, Van, UV Express, Delivery Truck, Jeepney, Motorcycle, etc.)

Name of Relationship Date Acquisition Availed of Balance to

Brand Model Year
Owner* with student Acquired Cost Loan (Y/N) be paid

* If Company Owned, please attach a copy of the latest OR and CR.

HOLIDAY/VACATION

Did the family go on vacation within the last 5 years? q Yes q No

Abroad? q Yes q No Province/s? q Yes q No
If yes, please list country and province.
Country/Province When? How often? Who shoulder the expenses?

EDUCATIONAL PLAN

Are any of your children enrolled in any educational plan? q Yes q No

If yes, please specify which company and plan you availed of.

Student No.: ______________

Name of Company Type of Plan
q Grade School q High School q College q All
q Grade School q High School q College q All
q Grade School q High School q College q All
q Grade School q High School q College q All

CERTIFICATION

We hereby certify that the above information is true and accurate. We also agree and promise to cooperate
with representatives of the school who will visit us for an interview in connection with this application. We
further agree that if any information is found inaccurate, the Committee reserves the right to
Grade and Section: ____________
reject/cancel our application.

Father’s Signature over Printed Name Date

Mother’s Signature over Printed Name Date

Guardian’s Signature over Printed Name Date

- - - - - - - - - - - - - - - - - - - - - - - - - - - Please Do Not Write Below This Line - - - - - - - - - - - - - - - - - - - - - - - - - -
Required documents have been checked and found to be complete.

Grant-in-Aid Officer Date Received / Date Checked

6
FAMILY PICTURE

Student Name: __________________________________________________

Paste recent and clear
FAMILY PICTURE
Only immediate family members should be in the picture
Size: 3R or 3.5” x 5”

Please write the names of your family members. (Left to Right)

Student No.: ______________

st
1 Row:
nd
2 Row:

Grade and Section: ____________

7
RESIDENCE/HOUSE PICTURES

Student Name: __________________________________________________

Paste recent and clear
FULL VIEW OF THE HOUSE
Size: 3R or 3.5” x 5”

Student No.: ______________

Paste recent and clear
MAIN AND DIRTY KITCHEN WITH THE REFRIGERATOR
Size: 3R or 3.5” x 5”
Grade and Section: ____________

8
 LOCATION MAP OF THE RESIDENCE

Student’s Name:
LEGAL NAME LAST NAME FIRST NAME MIDDLE NAME

Current Grade & Section: Student No.:

Home Tel. No.: Office Tel. No.: Mobile No.:

COMPLETE HOME ADDRESS

Please write in print.

Block # Lot # House # Building # Floor #

Street Subdivision/Village
Barangay Municipality/District
Town Province

Please sketch below the location of your house. Do not attach printed maps from Google, Yahoo, etc.
Kindly indicate a specific landmark (sari-sari store, bank, market, etc.) that can help the Home Visiting Team find
easily your place of residence. Please attach a clear, recent full view of your residence/house at the back.