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Hawak Kamay for Medicine Scholarship Application (External Students) 2023-2024
Application Period until March 30
* Indicates required question
Email
*
Your email
This scholarship program is open to college graduates or graduating students from other schools who wish to become a scholar in SWU PHINMA School of Medicine
Last name
*
Your answer
Middle Name(write N/A if not applicable)
*
Your answer
First Name
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Your answer
Birthdate
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MM
/
DD
/
YYYY
Facebook Name
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Your answer
Present Address
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Your answer
Permanent Address
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Your answer
Region
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Region I – Ilocos Region
Region II – Cagayan Valley
Region III – Central Luzon
Region IV‑A – CALABARZON
Region IV-B – MIMAROPA Region
Region V – Bicol Region
Region VI – Western Visayas
Region VII – Central Visayas
Region VIII – Eastern Visayas
Region IX – Zamboanga Peninsula
Region X – Northern Mindanao
Region XI – Davao Region
Region XII – SOCCSKSARGEN
Region XIII – Caraga
NCR – National Capital Region
CAR – Cordillera Administrative Region
BARMM – Bangsamoro Autonomous Region in Muslim Mindanao
Province
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Your answer
City
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Your answer
Contact Number
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Your answer
Undergraduate School
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Your answer
Undergraduate Degree/Course
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BS Med Tech
BS Physical Therapy
BS Nursing
BS Biology
BS Biological Sciences
BS Pharmacy
BS Rad Tech
Doctor of Optometry
Doctor of Dental Medicine
Doctor of Veterinary Medicine
BS Nutrition & Dietetics
BS Midwifery
BS Psychology
Other:
Year Graduating/Graduated
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Your answer
In which region does the family live?
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ARMM
Ilocos
Cagayan Valley
Central Luzon
Calabarzon
Mimaropa
Western Mindanao
Bicol
Western Visayas
Central Visayas
Eastern Visayas
Northern Mindanao
Southern Mindanao
Central Mindanao
NCR
CAR
CARAGA
How many members are there in the family? (exclude members who are overseas Filipinos)
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7 or more
5 or 6
4 and below
What is the highest grade completed by the head of the family?
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6th grade of school or lower
Some high school
Completed high school
What type of construction materials are the roofs made of?
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Light materials ( cogon, nipa, anahaw), Salvaged/makeshift materials, Mixed but predominantly light materials, Mixed but predominantly salvaged materials
Mixed but predominantly strong materials
Strong materials (galvanized iron, aluminum, tile, concrete, brick, stone, asbestos)
What type of construction materials are the outer walls made of?
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Light materials (bamboo, sawali, cogon, nipa, anahaw), Salvaged/makeshift materials, Mixed but predominantly light materials, Mixed but predominantly salvaged materials
Mixed but predominantly strong materials
Strong materials (galvanized iron, aluminum, tile, concrete, brick, stone, wood, plywood, asbestos)
Is there any electricity in the building/house?
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Yes
No
What is the family's main source of water supply?
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Dug well
Own use, faucet, community water system
Own use, tubed/piped deep well or Tubed/piped shallow well
Shared, faucet, community water system
Shared, tubed/piped deep well
Other:
Does the family own a Refrigerator/freezer?
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Yes
No
Does the family own a television set?
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Yes
No
Does the family own a washing machine?
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Yes
No
Family Combined Monthly Income
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Lower middle: P21,914 to P43,828 monthly income
Middle: P43,828 to P76,668 monthly income
Upper middle: P76,669 to P131,484 monthly income
Upper middle but not rich: P131,483 to P219,140 monthly income
Rich: P219,140 and above monthly income
Main Source of Income
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Government employment
Private employment
Self-employment / Business
Who is spending for your medical education?
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Parents
Myself
Grandparents
Relatives
Sponsors / Scholarships
PERSONAL DATA CONSENT: By accomplishing this Student Information Form, the student (1) certify that the information provided is true and complete, (2) acknowledge that the confidentiality of information is protected by the Data Privacy Act of 2012 (R.A. 10173), and (3) authorize the release of any and all academic, financial, and any other information that may be requested by the government for regulatory purposes or affiliates of the school to aid the school in achieving its purposes. The information will be available to the school until such time the consent is revoked in writing. *
*
AGREE
DISAGREE
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