Oss-ched Scholarship Form 5f355y

NOT FOR SALE

OSS-CHED SCHOLARSHIP FORM

Repulbic of the Philippines Office of the President COMMISSION ON HIGHER EDUCATION

2X2 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: [email protected]

APPLICATION FORM FOR SCHOLARSHIP AND STUDENT FINANCIAL ASSISTANCE PROGRAMS 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

Action Taken Award No. Date of Filing Region Province Cong. District

SCHOLARSHIP/ GRANT APPLIED FOR Scholarship Tulong-Dunong Grant Loan

Received by Authorized Official

PERSONAL INFORMATION

Printed Name & Signature)

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

(Middle Name) Citizenship: Number:

Rank in Class: Date of Exam:

FAMILY BACKGROUND Father

( ) Living

(

) Deceased

Name: Address: Occupation: Educational Attainment: Tribe hip (for SP-IEP only): Authenticated certificate from OPAPP (OPAPP-CHED SGP-RR only) Total Parents Gross Income: Brothers/Sisters Enjoying Scholarship: Name: Scholarship

Mother:

(

)

Living

(

)

Deceased

(ITR for 200____ attached) 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

Incomplete applications will not be processed. See the requirements at www.chedcaraga.com or @ http://chedscholars.blogspot.com

ara'07