application form (1)

OSS-CHED SCHOLARSHIP FORM

Republic of the PhilippinesOffice of the President

COMMISSION ON HIGHER EDUCATIONRegional Office 10

APPLICATION FORM FOR SCHOLARSHIP ANDSTUDENT FINANCIAL ASSISTANCE PROGRAMS

School Year 2013-2014Instruction: Action Taken1. Print all entries Award No.2. Place an X in the appropriate blank provided Date of Filing3. Fill in the portions specified for the program applied for Region

ProvinceGRANT APPLIED FOR: Cong'l District

Full Merit (FS) Tulong-Dunong (TD)(90 % and above GWA)

OPPAPP-CHED Study Grant Program for Rebel Received by Authorized Official

Returnees, Solo Parent)Half Merit (HS) (80-84% GWA)(85-89 % GWA) Others (pls. Specify) ___________________SNPLP Printed Name & Signature)

PERSONAL INFORMATION

Name(Last Name) (First Name) (Middle Name)

Age: Sex: Status: Religion: Citizenship:Date of Birth: Place of Birth:Complete Mailing Address: Tel./Mobile Number:

Home/Provincial Address:School Name (High School):School Address:School Type: ( ) Public ( ) Private ( ) Vocational Report Card Average:Highest Grade/Year: Date of Graduation: Rank in Graduating Class:National Career Assessment Examination (NCAE) GSA Percentile Rank: Date of Exam:Academic Awards/Honors Received: ________________________________________________________________________________Number of children in the family:________________

FAMILY BACKGROUNDFather ( ) Living ( ) Deceased Mother: ( ) Living ( )Name:Address:Occupation:Educational Attainment:Tribe Membership (for SP-IEP only):

Authenticated certificate from OPAPP (OPAPP-CHED SGP-RR only)Total Parents Gross Income: (ITR for 2011-12 attached)Brothers/Sisters Enjoying Scholarship:

Name: Scholarship Course and Year

School Intended to enroll in:Factor(s) that Motivated you to chose your course:Programs and Schools

Degree Program (Course) SchoolFirst Choice :Second Choice:Third Choice :

SIGNED DECLARATION BY THE PARENTS / LEGAL GUARDIAN

I / We hereby certify to the truthfullness and completeness of information provided. Any misinformation will automatically disqualifymy / our child from the CHED Scholarship Program. I / We are also willing to refund all financial benefits received plus the appropriateinterest such misinformation is discovered after my / our child accepted the reward.

In connection with this application for financial aide, I/we hereby authorize CHED-OSS/CHEDRO to conduct a background check on the family finances and to visit our family dwelling.

___________________________________ ___________________________________________(Applicant's Signature over Printed Name) (Parent's or Guardian's Signature over Printed Name)

(PWD, SP-IEP(Tribe), CHED DND PASUC,

Note: Fully accomplished form to be submitted to the CHED 10 Office on or before MARCH 31

2 X 2ID PICTURE

Documentary Requirements

- Latest BIR Income Tax Return (ITR) or Tax Exemption of parents; (max of 300, 000 for both parents)

- Certificate of Good Moral Character from the High School Principal or Guidance Counselor

- National Career Assessment Examination Rating.Full Merit (90% Above) Half Merit (85-89%) Others ( 84-80%)

Additional Requirements for the applicants to the following programs

top 10 of the graduating class.

National Commission on Indigenous Peoples.

child of a solo parent with an attached certification from a DSWD worker in the area;

(5) Notice of admission from the school where the applicant intends to enroll; (optional)

permanent resident of his/her congressional districts.

enrolled in; (2) official report of rating or certificate of grades for the last semester attended issued by the school registrar; (3) certificate of guarantor of loan by a bonifide member of GSIS or SSS, (4) certificate of good moral from school currently enrolled in, and (5) ITR or Tax Exempt. Cert.

CHED PRIORITY COURSES FROM AY 2011-2012 TO AY 2015-2016

(CHED MEMORANDUM ORDER No. 04, S. 2011) PRIORITY COURSES a. Health Sciences f.Teacher Education major in:

Ø Pharmacy ØMathØ Radiology Technology ØScienceØ Medical Technology ØPhysics

ØChemistryb. Information Technology ØReading

ØInformation Technology and Computing Studies ØEnglishØmulti Media ØEducational Media/TechnologyØAnimation ØSpecial Education (SPED)ØInformation System ManagementØProgramming g. Science and Math ØComputer Science ØBS Math ØBS Chemistry

ØBS Biologyc. Agriculture and Related Fields ØBS Physics

ØAgro ForestryØVeterinary Medicine LIST OF HIGHER EDUCATION INSTITUTIONS ØAgricultural Engineering 1 Cagayan de Oro College ØAgribusiness/Management 2 Capitol UniversityØAgricultural Entrepreneurship 3 La Salle UniversityØAgri-Tech 4 Liceo de Cagayan UniversityØAgriculture 5 Lourdes CollegeØFisheries 6 Pilgrim Christian College

7 Misamis Universityd. Engineering 8 Mountain View College

ØMechanical 9 Southern de Oro Philippines CollegeØElectronics 10 Saint Michael's College - Iligan CityØCommunication 11 Xavier UniversityØMetallurgical/Mining 12 Bukidnon State University - Malaybalay CityØComputer 13 Camiguin Polytechnic State CollegeØBiomedical 14 Central Mindanao University - BukidnonØChemical 15 Mindanao University of Science and TechnologyØGeodetic 16 Mindanao State University - Iligan Institute of TechnologyØElectrical 17 MOSCATØMeteorological 18 North Central Mindanao CollegeØMining (For grantees in grant-in-aid programs, they may study in any CHED ØGeological recognized higher education institution preferably in state colleges

and universities)e. Arts and Humanities; Atmospheric Sciences, and Environmental Sciences

- Form 137 of 3rd year & Form 138 of 4th year (photocopy signed by the Principal at least 3rd grading)

a. Full Merit (SF) - certification from the school principal that the applicant belongs to the

b. Rebel Returnees/Integrees - Authenticated certificate from OPAPP that the applicant is a bonafide rebelc. SGP-IEP - Certification of membership either by the Office of Muslim Affairs or the

d. Solo Parent - (1) Affidavit duly executed by the applicant that he/she is a solo parent or a

(2) Certification of good moral character from the Barangay Chairman of the place of domicile;(Parent) (3) Certification of good health;(applicant) (4) Birth Certificate;(applicant)

(6) ID of solo parent.(parent)e. SSGP - Certification from the congressman that the applicant is a

f. SNPLP for Ongoing College Student – (1) Official enrolment certificate and statement of accounts from school

SNPLP for Incoming College Student - Cert. Of Guarantor and the Documentary requirements stated above

Republic of the PhilippinesOffice of the President

COMMISSION ON HIGHER EDUCATIONRegional Office 10

APPLICATION FORM FOR SCHOLARSHIP ANDSTUDENT FINANCIAL ASSISTANCE PROGRAMS

Pls Fill-upPls Fill-up

Received by Authorized Official

Printed Name & Signature)

Academic Awards/Honors Received: ________________________________________________________________________________

FAMILY BACKGROUNDDeceased

attached)

Course and Year

School

SIGNED DECLARATION BY THE PARENTS / LEGAL GUARDIAN


In connection with this application for financial aide, I/we hereby authorize CHED-OSS/CHEDRO to conduct a background check on

___________________________________________(Parent's or Guardian's Signature over Printed Name)

2 X 2ID PICTURE

Documentary Requirements


issued by the school registrar; (3) certificate of guarantor of loan by a bonifide member of GSIS or SSS, (4) certificate of good moral from school currently enrolled in, and (5) ITR or Tax Exempt. Cert.


(CHED MEMORANDUM ORDER No. 04, S. 2011)

Mindanao State University - Iligan Institute of Technology

– (1) Official enrolment certificate and statement of accounts from school

Revise OSS Form No. 1

2012 version

Office of the President of the PhilippinesCOMMISSION ON HIGHER EDUCATION

Regional Office 10 Tel. No. 71-12-31

CHED STUDENT FINANCIAL ASSISTANCE PROGRAMS (StuFAPs)APPLICATION FORM

SY 2014-15

Instruction: Read General and Documentary Requirements. Fill-in all the required information. Do not leave an item blank. If an item is not applicable, indicate "N/A".

PERSONAL INFORMATION

Name(Last Name) (First Name) (Middle Name)

Permanent Mailing

Place of Birth Address

Sex Male Female Zip Code

Civil Status Single Widowed School Name

Married Separated School Address

Annulled Others

Citizenship School Type Public Private

Mobile Number Highest Grade/Year

E-mail Address Type of Disability (if applicable)

FAMILY BACKGROUNDFather ( ) Living ( ) Deceased Mother: ( ) Living ( ) Deceased

Name:Address:Occupation:Educational Attainment:Total Parents Gross Income: No. Of Siblings in the family

Brothers/Sisters Enjoying Scholarship:Name: Scholarship Course and Year

School Intended to enroll in:School AddressType of School ( ) Public ( ) Private

CourseSIGNED DECLARATION BY THE PARENTS / LEGAL GUARDIAN


In connection with this application for financial aide, I/we hereby authorize CHED-OSS/CHEDRO to conduct a background check on the family finances and to visit our family dwelling.

___________________________________(Applicant's Signature over Printed Name) (Parent's or Guardian's Signature over Printed Name)

DO NOT FILL-OUT THIS [PORTION (FOR CHED USE ONLY)

Applicant is Qualified for: Belongs to: (any of the following groups) Documents Attached: Equivalent PointsScholarship solo parent and their dependents Form 139 =Grants-in-Aid senior citizens Latest ITR P =Student Loan persons with disabilities No. Of siblings in the family =

indigenous and ethnic peoples Total

Evaluated/Processed By:

CHED StuFAP CoordinatorGeneral Requirements: Documentary Requirements:

1. Must be a Filipino citizen of good moral character 1. Accomplished CHED StuFAPs Application (OSS Form 01)2. Must not be more than 30 years of age at the time of application 2. Duly certified High School Report Card for third year and grades for the first three

except for senior citizens grading periods for fourth year3. Must be a high school graduate or a candidate for graduation 3. Latest Income Tax Return (ITR), Certificate of Tax Exemption or Copy of4. Must have a combined annual gross income of parents/guardian not to exceed Contract or proof of income of parents/guardian from BIR.

Three Hundred Thousand Pesos (P300,000.00). For those who are exempted from 4. Certificate of good moral character from the high school principal/guidancefiling income tax, there should be a certificate of tax exemption from the BIR. For counselor. OFW and Seafarers, a latest copy of contract or proof of income.

5. Must not be a recipient of any government and financial assistance

Date of Birth (mm/dd/yy)

Note: Fully accomplished form to be submitted to the CHED 10 Office on or before MARCH 31

2 X 2ID PICTURE


National Commission on Indigenous Peoples.

child of a solo parent with an attached certification from a DSWD worker in the area;

(5) Notice of admission from the school where the applicant intends to enroll; (optional)

permanent resident of his/her congressional districts.

enrolled in; (2) official report of rating or certificate of grades for the last semester attended issued by the school registrar; (3) certificate of guarantor of loan by a bonafide member of GSIS or SSS, (4) certificate of good moral from school currently enrolled in, and (5) ITR or Tax Exempt. Cert.

f.


(CHED MEMORANDUM ORDER No. 04, S. 2011) PRIORITY COURSES a. Health Sciences f.Teacher Education major in:

Ø Pharmacy ØMathØ Radiology Technology ØScienceØ Medical Technology ØPhysics

ØChemistryb. Information Technology ØReading

ØInformation Technology and Computing Studies ØEnglishØMulti Media ØEducational Media/TechnologyØAnimation ØSpecial Education (SPED)ØInformation System ManagementØProgramming g. Science and Math ØComputer Science ØBS Math ØBS Chemistry

ØBS Biologyc. Agriculture and Related Fields ØBS Physics

ØAgro ForestryØVeterinary Medicine LIST OF HIGHER EDUCATION INSTITUTIONS ØAgricultural Engineering 1 Cagayan de Oro College ØAgribusiness/Management 2 Capitol UniversityØAgricultural Entrepreneurship 3 La Salle UniversityØAgri-Tech 4 Liceo de Cagayan UniversityØAgriculture 5 Lourdes CollegeØFisheries 6 Pilgrim Christian College

7 Misamis Universityd. Engineering 8 Mountain View College

ØMechanical 9 Southern de Oro Philippines CollegeØElectronics 10 Saint Michael's College - Iligan CityØCommunication 11 Xavier UniversityØMetallurgical/Mining 12 Bukidnon State University - Malaybalay CityØComputer 13 Camiguin Polytechnic State CollegeØBiomedical 14 Central Mindanao University - BukidnonØChemical 15 Mindanao University of Science and TechnologyØGeodetic 16 Mindanao State University - Iligan Institute of TechnologyØElectrical 17 MOSCATØMeteorological 18 North Central Mindanao CollegeØMining (For grantees in grant-in-aid programs, they may study in any CHED ØGeological recognized higher education institution preferably in state colleges

and universities)e. Arts and Humanities; Atmospheric Sciences, and Environmental Sciences

a. Rebel Returnees/Integrees - Authenticated certificate from OPAPP that the applicant is a bonafide rebelb. SGP-IEP - Certification of membership either by the Office of Muslim Affairs or the

c. Solo Parent - (1) Affidavit duly executed by the applicant that he/she is a solo parent or a

(2) Certification of good moral character from the Barangay Chairman of the place of domicile;(Parent) (3) Certification of good health;(applicant) (4) Birth Certificate;(applicant)

(6) ID of solo parent.(parent)d. SSGP - Certification from the congressman that the applicant is a

e. SNPLP for Ongoing College Student – (1) Official enrolment certificate and statement of accounts from school

SNPLP for Incoming College Student - Cert. Of Guarantor and the Documentary requirements stated above

Mindanao State University - Iligan Institute of Technology