GBF-GOKONGWEI GROUP STEM SCHOLARSHIP FOR EXCELLENCE

Gearing up future-ready STEM leaders

GBF in partnership with select Gokongweig Group Companies offers the scholarship to the best students pursuing STEM (science, technology, engineering, mathematics) in
top-ranked universities in the Philippines. Envisioning to groom future leaders of the Gokongwei Group, the different
Gokongwei Group companies closely administer the scholarship with GBF for industry immersion, mentoring, and potential employment of scholars.

APPLICATION FORM
Admission Year: Academic Year 2020-2021
INSTRUCTIONS

1. Accomplish the application form. Write "N/A" in fields that are not applicable to you.
2. Affix colored photo and digital signature on the appropriate spaces.
3. Save the application form as a PDF file.
4. Use the following filename format: [SCHOOL NAME] underscore [NAME OF APPLICANT] (e.g. PUP Manila_John Cruz)
5. Send the accomplished forms and all requirements listed before the signature line to [email protected].

DATA PRIVACY NOTICE AND CONSENT

By accomplishing this scholarship application form and providing personal information, you are granting full consent to Gokongwei Brothers Foundation to collect and use your personal information for the
your scholarship application, and (2) sending of news, updates, and invitations relating to GBF programs and advocacy. In compliance with Republic Act No. 10173, otherwise known as the Data Privacy Ac
Foundation shall take reasonable steps to protect any personal data you provide and to protect such information from misuse and unauthorized access, disclosure, alteration, or destruction. Gokongwei Bro
personal information collected in this application form for as long as necessary or as permitted by applicable law. Should you wish to withdraw your consent, please get in touch with us through our websit
org or email us at [email protected].

PERSONAL & CONTACT INFORMATION

Full Name: Oineza, Jellu, Casta Age:

Last Name, First Name, Middle Name

Current City: Bani Home Province: Pangasinan Nickname: N/A

Where do you live at present? Where are you originally from?

Contact No.: 09460386607/09662657727 Email Address: [email protected]

ACADEMIC STANDING IN A.Y. 2020-2021 & DEGREE PROGRAM DETAILS

Bachelor of Science in Mechanical E

Course: University: Pangasinan State University Urdaneta C
ngineering

Semestral Sem 1:______; Se

Expected Year
Year Level: 2nd Year 2023 Academic Calendar: Trimester 1st: ____; 2nd: __
of Graduation: 1st: ____; 2nd: ____; 3
Quadri.
Indicate

Existing Scholarships:
Program Length (Years) 4 Kindly enumerate, if any
DOST Undergraduate Scholarship
No. of full-time study years to complete degree

General Average in High School Rank among out of

(%): High School Batch: Rank
For 1st Year College Applicants
If yes, list subjects (e.
Did you get any Failing Mark in High School? No Yes

Cumulative General Weighted 1.93 out of 48.00 5 out of

Rank among Course Batch:
For 2nd Year Average: As of Previous Semester Rank
or Older Applicants
If yes, list subjects (e.g. F/DRP
Have you had any Failing, Dropped, or Incomplete Mark in College? No Yes

OJT Period: If done, indicate company

Required OJT Hours:
Indicate Year Level where OJT was rendered:

AFFILIATIONS
Organization
Please spell out acronyms
Period Covered Highest Position Held Key Contri

N/A

ACADEMIC & EXTRA-CURRICULAR ACHIEVEMENTS

Date Given
Start from recent
Award Title Given By Nature/Ca

N/A

FAMILY INCOME

1. How many siblings do you have? 3 2. Annual Family Income 150,000

3. Are you now or were you ever employed?

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 Position Company/Organization Period Covered Status
If Applicable

N/A Full Time Part Time

Full Time Part Time

Full Time Part Time

4. Who among your family members or relatives support your family financially?
Relationship Company/Organization
Write relationship only (e.g. father, Occupation/Work If Applicable
Status F
mother), not name.

Father Bus Dispatcher Dagupan Bus Company Full Time Part Time 150

Full Time Part Time

Full Time Part Time

Full Time Part Time

Full Time Part Time

ESSAY (Important Note: Answers should be between 100 and 200 words only.)

1. Why did you take your course?

5

2. Where do you see yourself in your career three years from now?

3. What top two values and principles do you live by? Cite concrete examples that show when and how you displayed these.

4. As a student, how have you contributed to your community?

APPLICATION SUBMISSION
1. Should I be accepted to the program, I am willing to work for any Gokongwei Group Company after graduation.

2. I hereby submit this application form together with the following requirements:
1 of 3: General Requirements
Duly accomplished and signed application form submitted in PDF format

2 of 3: Proof of Good Academic Standing

A. For incoming or current 1st year college applicants B. For incoming or current 2nd year college or older applicants
Original transcript of records in junior and senior high school Certified true copy of grades from 1st year college up to recent semester
Certification from recent high school that applicant belongs to top 10% Certification from college/university that applicant belongs to top 30%* of cou
of the batch Certificate of Good Moral Standing issued by your university
Certificate of Good Moral Standing issued by your high school *may vary according to course

3 of 3: Proof of Income
Income tax return or last two payslips of primary income earner in the family, or Certificate of Indigency

3. I hereby affirm to the best of my knowledge that all answers to the foregoing are true and correct. I also authorize Gokongwei Brothers Foundation to inquire as to my record from any or all of the schools
misinterpretation in the foregoing answers and date may disqualify my admission to the program.

Signature

Applicant's Full Name Signature Da

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 following purposes: (1) evaluation of
t of 2012, Gokongwei Brothers
others Foundation shall retain the
te www.gokongweibrothersfoundation

19

City Campus

em 2:______
___; 3rd: ____
3rd: ____; 4th: ____
month when term begins

No. of Students

g. Gr. 10 Math):

No. of Students

P/INC-1st year-Math 17):

butions

ategory

of 4
 Monthly Earnings

Monthly Earnings
For relatives, amount of financial
support

0000

urse batch

I have attended. Any

ate Accomplished

v.29 July 2020

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