OSS-CHED SCHOLARSHIP FORM NOT FOR SALE

Repulbic of the Philippines

Office of the President 2X2
COMMISSION ON HIGHER EDUCATION ID PICTURE
3rd Flr. National Engineering Center
U.P. Diliman, Quezon City
Tel. No.: 02-426-98-65 Telefax: 02-426-98-71
www.ched.gov.ph
Email Address: ched_oss@easycall.com.ph

APPLICATION FORM FOR SCHOLARSHIP AND

STUDENT FINANCIAL ASSISTANCE PROGRAMS
Instruction: Action Taken
1. Print all entries Award No.
2. Place an X in the appropriate blank provided Date of Filing
3. Fill in the portions specified for the program applied for Region
Province
SCHOLARSHIP/ GRANT APPLIED FOR Cong. District
Scholarship
Tulong-Dunong Grant
Loan
Received by Authorized Official

PERSONAL INFORMATION Printed Name & Signature)

Name
(Last Name) (First Name) (Middle Name)
Age: Sex: Status: Religion: Citizenship:
Date of Birth: Place of Birth:
Mailing Address: Contact Number:
Home/Provincial Address:
School Name (High School):
School Address:
School Type: ( ) Public ( ) Private ( ) Vocational
Highest Grade/Year: Date of Graduation: Rank in Class:
National Career Assestment Examination (NCAE) Score: Date of Exam:
Academic Awards/Honors Received:

FAMILY BACKGROUND

Father ( ) Living ( ) Deceased Mother: ( ) Living ( ) Deceased

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 200____ 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) School
First 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 or witholding information will automatically disqualify
my/ our child from the CHED Scholarship program. I/ We are also willing to refund all financial benefits rfecieved plus the appropriate interest such
misinformation is discovered/ our child accepted the reward.

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

Applicant's Signature Over Printed Name Parent's or Guardian's Signature over Printed Name

Date
Note: Fully accomplished form to be submitted to CHEDRO Caraga, NORMISIST Campus, Ampayon, Butuan City on or before April 15 ara'07
Incomplete applications will not be processed. See the requirements at www.chedcaraga.com or @ http://chedscholars.blogspot.com