Name of Applicant Scholar: ___________________________________

Home / Sending HEI: _______________________________________

Program applied for: _________________________________________

Documents Submitted:

Document / s Complied Not Complied

Date Complied

For

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HED

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1. Scholarship application form

List of courses offered by SHEI*

Total College/University Enrollment

Certification from School Head

Teaching Load

Certification that grantee has no pending administrative charges

Certification that grantee has no pending scholarship program being undertaken

Certification of employment indicating Official Designation, Status of Employment (Full/Part-Time), Tenure (Permanent, Probationary, Contractual or Temporary) and Date hired.

2. Recommendation

3. Transcript of Records (for every course taken: BA/BS, MA/MS, units earned)

4. Rehiring Agreement (if not permanent in SHEI)

5. Medical Certificate

Doctor’s Certificate (to be administered by a Government physician)

Urinalysis

Fecalysis

Complete Blood Count

X-ray result

6. NBI or Police Clearance

7. Birth Certificate (Issued by NSO)

8. SHEI Institutional Faculty Plan

Aft

e 9 Signed Scholarship Contract (5 copies)

10. Co-maker Undertaking (5 copies)

Picture ofApplicant

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HE

D 11. Income Tax Return of Co-maker

12. Photocopy of any valid ID/Passport

*SHEI – Sending Higher Education Institution