OSS-CHED SCHOLARSHIP FORM

Republic of the Philippines Office of the President COMMISSION ON HIGHER EDUCATION Regional Office 10

2X2 ID PICTURE

APPLICATION FORM FOR SCHOLARSHIP AND STUDENT FINANCIAL ASSISTANCE PROGRAMS

School Year 2013-2014 Instruction: 1. Print all entries 2. Place an X in the appropriate blank provided 3. Fill in the portions specified for the program applied for GRANT APPLIED FOR: Full Merit (FS) (90 % and above GWA) Action Taken Award No. Date of Filing Region Province Cong'l District

Half Merit (HS) (85-89 % GWA) SNPLP

Tulong-Dunong (TD) (PWD, SP-IEP(Tribe) , CHED DND PASUC, OPPAPP-CHED Study Grant Program for Rebel Returnees, Solo Parent) (80-84% GWA) Others (pls. Specify) ___________________

Received by Authorized Official

Printed Name & Signature)

PERSONAL INFORMATION
Name (Last Name) Age: Sex: Date of Birth: Complete Mailing Address: Status: (First Name) Religion: Place of Birth: (Middle Name) Citizenship: 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 BACKGROUND
Father ( ) Living ( ) Deceased Mother: Name: Address: Occupation: Educational Attainment: Tribe Membership (for SP-IEP only): Authenticated certificate from OPAPP (OPAPP-CHED SGP-RR only) Total Parents Gross Income: Brothers/Sisters Enjoying Scholarship: Name: Scholarship ( ) Living ( )

(ITR for 2011-12 attached) Course and Year

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

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

School

SIGNED DECLARATION BY THE PARENTS / LEGAL GUARDIAN

I / We hereby certify to the truthfullness and completeness of information provided. Any misinformation will automatically disqualify my / our child from the CHED Scholarship Program. I / We are also willing to refund all financial benefits received plus the appropriate interest 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)
Note: Fully accomplished form to be submitted to the CHED 10 Office on or before

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

MARCH 31

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

a. Full Merit (SF) - certification from the school principal that the applicant belongs to the top 10 of the graduating class. b. Rebel Returnees/Integrees - Authenticated certificate from OPAPP that the applicant is a bonafide rebel c. SGP-IEP - Certification of membership either by the Office of Muslim Affairs or the National Commission on Indigenous Peoples. d. Solo Parent - (1) Affidavit duly executed by the applicant that he/she is a solo parent or a child of a solo parent with an attached certification from a DSWD worker in the area; (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) (5) Notice of admission from the school where the applicant intends to enroll; (optional) (6) ID of solo parent.(parent) e. SSGP - Certification from the congressman that the applicant is a permanent resident of his/her congressional districts. f. SNPLP for Ongoing College Student (1) Official enrolment certificate and statement of accounts from school 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. SNPLP for Incoming College Student - Cert. Of Guarantor and the Documentary requirements stated above
CHED PRIORITY COURSES FROM AY 2011-2012 TO AY 2015-2016 (CHED MEMORANDUM ORDER No. 04, S. 2011) PRIORITY COURSES a. Health Sciences Pharmacy Radiology Technology Medical Technology b. Information Technology Information Technology and Computing Studies multi Media Animation Information System Management Programming Computer Science c. Agriculture and Related Fields Agro Forestry Veterinary Medicine Agricultural Engineering Agribusiness/Management Agricultural Entrepreneurship Agri-Tech Agriculture Fisheries f.Teacher Education major in: Math Science Physics Chemistry Reading English Educational Media/Technology Special Education (SPED) g. Science and Math BS Math BS Biology BS Physics

BS Chemistry

LIST OF HIGHER EDUCATION INSTITUTIONS 1 Cagayan de Oro College 2 Capitol University 3 La Salle University 4 Liceo de Cagayan University 5 Lourdes College 6 Pilgrim Christian College 7 Misamis University d. Engineering 8 Mountain View College Mechanical 9 Southern de Oro Philippines College Electronics 10 Saint Michael's College - Iligan City Communication 11 Xavier University Metallurgical/Mining 12 Bukidnon State University - Malaybalay City Computer 13 Camiguin Polytechnic State College Biomedical 14 Central Mindanao University - Bukidnon Chemical 15 Mindanao University of Science and Technology Geodetic 16 Mindanao State University - Iligan Institute of Technology Electrical 17 MOSCAT Meteorological 18 North Central Mindanao College Mining (For grantees in grant-in-aid programs, they may study in any CHED Geological recognized higher education institution preferably in state colleges and universities) e. Arts and Humanities; Atmospheric Sciences, and Environmental Sciences

Republic of the Philippines Office of the President MMISSION ON HIGHER EDUCATION Regional Office 10

ID PICTURE

TION FORM FOR SCHOLARSHIP AND FINANCIAL ASSISTANCE PROGRAMS

Pls Fill-up Pls Fill-up

Received by Authorized Official

Printed Name & Signature)

Rank in Graduating Class:

_____________________________________________________________________

FAMILY BACKGROUND
Deceased

attached) Course and Year

School

RATION BY THE PARENTS / LEGAL GUARDIAN

teness of information provided. Any misinformation will automatically disqualify I / We are also willing to refund all financial benefits received plus the appropriate / our child accepted the reward. I/we hereby authorize CHED-OSS/CHEDRO to conduct a background check on

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

umentary Requirements

nts for the applicants to the following programs

Official enrolment certificate and statement of accounts from school

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

CHED PRIORITY COURSES OM AY 2011-2012 TO AY 2015-2016 D MEMORANDUM ORDER No. 04, S. 2011)

Mindanao State University - Iligan Institute of Technology

Revise OSS Form No. 1 2012 version

Office of the President of the Philippines COMMISSION ON HIGHER EDUCATION Regional Office 10 Tel. No. 71-12-31

2X2 ID PICTURE

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 Date of Birth (mm/dd/yy) Place of Birth Sex Civil Status
Male Single Married Annulled Female Widowed Separated Others (Last Name) (First Name) (Middle Name)

Permanent Mailing Address Zip Code School Name School Address School Type Public Highest Grade/Year Type of Disability (if applicable) Private

Citizenship Mobile Number E-mail Address

FAMILY BACKGROUND
Father ( ) Living Name: Address: Occupation: Educational Attainment: Total Parents Gross Income: Brothers/Sisters Enjoying Scholarship: Name: Scholarship ( ) Deceased Mother: ( ) Living ( ) Deceased

No. Of Siblings in the family Course and Year

School Intended to enroll in:

School Address Type of School Course

) Public

) Private

SIGNED DECLARATION BY THE PARENTS / LEGAL GUARDIAN

I / We hereby certify to the truthfullness and completeness of information provided. Any misinformation will automatically disqualify my / our child from the CHED Scholarship Program. I / We are also willing to refund all financial benefits received plus the appropriate interest 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)
Note: Fully accomplished form to be submitted to the CHED 10 Office on or before DO NOT FILL-OUT THIS [PORTION (FOR CHED USE ONLY)

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

MARCH 31

Applicant is Qualified for: Scholarship Grants-in-Aid Student Loan

Belongs to: (any of the following groups) solo parent and their dependents senior citizens persons with disabilities indigenous and ethnic peoples

Documents Attached: Form 139 Latest ITR

No. Of siblings in the family

Equivalent Points P Total = = =

Evaluated/Processed By:

CHED StuFAP Coordinator General Requirements: 1. Must be a Filipino citizen of good moral character 2. Must not be more than 30 years of age at the time of application except for senior citizens 3. Must be a high school graduate or a candidate for graduation 4. Must have a combined annual gross income of parents/guardian not to exceed Three Hundred Thousand Pesos (P300,000.00). For those who are exempted from filing income tax, there should be a certificate of tax exemption from the BIR. For OFW and Seafarers, a latest copy of contract or proof of income. 5. Must not be a recipient of any government and financial assistance Documentary Requirements: 1. Accomplished CHED StuFAPs Application (OSS Form 01) 2. Duly certified High School Report Card for third year and grades for the first three grading periods for fourth year 3. Latest Income Tax Return (ITR), Certificate of Tax Exemption or Copy of Contract or proof of income of parents/guardian from BIR. 4. Certificate of good moral character from the high school principal/guidance counselor.

Additional Requirements for the applicants to the following programs

a. Rebel Returnees/Integrees - Authenticated certificate from OPAPP that the applicant is a bonafide rebel b. SGP-IEP - Certification of membership either by the Office of Muslim Affairs or the National Commission on Indigenous Peoples. c. Solo Parent - (1) Affidavit duly executed by the applicant that he/she is a solo parent or a child of a solo parent with an attached certification from a DSWD worker in the area; (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) (5) Notice of admission from the school where the applicant intends to enroll; (optional) (6) ID of solo parent.(parent) d. SSGP - Certification from the congressman that the applicant is a permanent resident of his/her congressional districts. e. SNPLP for Ongoing College Student (1) Official enrolment certificate and statement of accounts from school 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. SNPLP for Incoming College Student - Cert. Of Guarantor and the Documentary requirements stated above f.
CHED PRIORITY COURSES FROM AY 2011-2012 TO AY 2015-2016 (CHED MEMORANDUM ORDER No. 04, S. 2011) PRIORITY COURSES a. Health Sciences Pharmacy Radiology Technology Medical Technology f.Teacher Education major in: Math Science Physics Chemistry Reading English Educational Media/Technology Special Education (SPED) g. Science and Math BS Math BS Chemistry BS Biology BS Physics

b. Information Technology Information Technology and Computing Studies Multi Media Animation Information System Management Programming Computer Science c. Agriculture and Related Fields Agro Forestry Veterinary Medicine Agricultural Engineering Agribusiness/Management Agricultural Entrepreneurship Agri-Tech Agriculture Fisheries

LIST OF HIGHER EDUCATION INSTITUTIONS 1 Cagayan de Oro College 2 Capitol University 3 La Salle University 4 Liceo de Cagayan University 5 Lourdes College 6 Pilgrim Christian College 7 Misamis University d. Engineering 8 Mountain View College Mechanical 9 Southern de Oro Philippines College Electronics 10 Saint Michael's College - Iligan City Communication 11 Xavier University Metallurgical/Mining 12 Bukidnon State University - Malaybalay City Computer 13 Camiguin Polytechnic State College Biomedical 14 Central Mindanao University - Bukidnon Chemical 15 Mindanao University of Science and Technology Geodetic 16 Mindanao State University - Iligan Institute of Technology Electrical 17 MOSCAT Meteorological 18 North Central Mindanao College Mining (For grantees in grant-in-aid programs, they may study in any CHED Geological recognized higher education institution preferably in state colleges and universities) e. Arts and Humanities; Atmospheric Sciences, and Environmental Sciences

e of Technology