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Edsp Form Rev2010

Edsp Form Rev2010

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Published by: Marco Bernabe Jumaquio on Aug 30, 2010
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10/23/2011

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FORM 1
Application No._______________ 
 
NOT FOR SALE
(can be reproduced)
Republic of the PhilippinesDepartment of Labor and Employment
Overseas Workers Welfare Administration
RegionPrograms Services DivisionEDUCATION & TRAINING UNIT
APPLICATION FORM
SCHOLARSHIP / TRAINING PROGRAM APPLIED FOR
:
[ ]Education for Development Scholarship Program
(EDSP)
[ ]Congressional Migrant Workers Scholarship Program
(CMWSP)
I. INFORMATION SHEET (Note: Please PRINT LEGIBLY)
 1. Name: _____________________________________________ 2. Age___ 3. Birthdate _______4. Sex: F [ ] M [ ] 
LAST FIRST MIDDLE
5. Permanent Address: _____________________________________________________ 6. Civil Status______________ Municipality / District: _______________________________ Zip Code: ____________ 7. Citizenship______________ 8. High School Attended: __________________________________________________ 9. Tel No. _________________ 10. School Address : ________________________________________________________ Mobile No._______________ 11.Gen. Average in 4
th
Year High School _____________________ 
12. PARENTS’ INFORMATION 
a. Name:b. Citizenship:c. Highest Education Attained:d. Tribal Affiliation (if any):e. Occupation:f. Employer Address:g. Gross Income:
FATHER _____________________________________________________  _____________________________________________________  _____________________________________________________  _____________________________________________________  _____________________________________________________  _____________________________________________________ MOTHER ______________________________________________________  ______________________________________________________  ______________________________________________________  ______________________________________________________  ______________________________________________________  ______________________________________________________ 
No. of Siblings in the Family : _______ Family Order : 1
st
[ ] 2
nd
[ ] 3
rd
[ ] Others: _______ 
I hereby certify that all answers given above are true and correct to the best of myknowledge. I will also abide with the policy of the program that selection of qualified examinees for scholarship award after approval of the Administrator is final and unappealable.Attested by:
EDSPCMWSP
Parent / Guardian(Signature Over Printed Name)Applicant(Signature Over Printed Name)Date: ____________________________ 
 
Republic of the PhilippinesDepartment of Labor and Employment
Overseas Workers Welfare Administration
RegionPrograms Services DivisionEDUCATION & TRAINING UNIT
EVALUATION FORM
[ ] Education for Development Scholarship Program (EDSP)[ ] Congressional Migrant Workers Scholarship Program (CMWSP)
 A. APPLICANT’S
 
DATA
 Name _____________________________________________ Last First Middle Age:___ Birthdate:_______ Citizenship________ Sex: M [ ] F [ ]Relationship to OFW __________ Tel.No _________________ Preferred Course:_____________________________________ PreferredSchool:_____________________________________
B. OFW DATA:
Name of OFW : _________________________________ Last First MiddleOccupation/Jobsite : ________________________________ Category: LB [ ] SB [ ] SEX: M [ ]
 
F
 
[ ]Civil Status: S[ ] M [ ] Region: _____________ Latest Date of OWWA Contribution : ___________________ Term of Contract: _________________________________ 
C. REQUIREMENTS R E M A R K S
1. [ ] Application Form _______________________ 2. [ ] Two (2) 2” x 2” recent & Identical Photos _______________________ 3. [ ] Proof of OWWA Membership __ Official Receipt of OWWA Contribution _______________________  __ OFW Verification Sheet issued by MPC _______________________ 4. [ ] Proof of Relationship to OWWA-Member/OFW__ Birth Certificate (issued by
NSO
) of applicant, if child of OFW _______________________ __ Birth Certificate (issued by
NSO
) of both applicant & OFW, if OFW's brother/sister (for CMWSP) __________________ __ Certificate of No Marriage (
CENOMAR
) from
NSO
(
if OFW is unmarried
) _______________________ 5. [ ] Secondary School Record (Form 137) _______________________ 6. [ ] Health Certificate _______________________ 7. [ ] Certificate of Good Moral Character _______________________ 8. [ ] Certification that applicant belongs to the upper 20% of the High School Graduating Class _______________________ 9. [ ] Applicant’s Certificate of not having taken post secondary or undergraduate/ college unitsand not a Recipient of any scholarship grant / has not taken the EDSP Qualifying Examination _____________________ 10.[ ] Sworn Statement that applicant has no pending application for resident immigrant statusfrom any country & does not have dual citizenship ________________________ 
D. ALTERNATE/OTHER REQUIREMENTS :
 _____________________________________________________________________ 
 _____________________________________  ______________________________________________________________________________________________  _______________________________________ 
E. EVALUATION REPORT:
 
[ ] Eligible [ ] Not Eligible [ ] Lacking Documents
Received by
: _______________________________ Date: _______________________________ 
Evaluated by:
 __________________________ Chief, Programs Services DivisionDate: _____________________________ 
 
APPROVED
:OWWA Regional Welfare Office Director Date
 
A.
 
HEALTH CERTIFICATE
MEDICAL CLINIC: ________________________________________________________ ADDRESS: _______________________________________________________________________________________________________________ DATE: __________________ TO WHOM IT MAY CONCERN:This is to certify that I have examined __________________________________ and found him/her to be:Physically fitPhysically unfitfor scholarship application.This certification is issued in connection with his/her application for the Education for DevelopmentScholarship Program (EDSP) for the SY 2009 - 2010.  ____________________________ Medical Officer  
(Signature Over Printed Name)
LC # _______________________ *********************************************************************************
B. CERTIFICATE OF GOOD MORAL CHARACTER 
This is to certify that ____________________________ is of good moral character and that nodisciplinary action has been taken against him/her as of date. ___________________________ Principal / Guidance Counselor 
(Signature Over Printed Name)
Date: _______________________ *********************************************************************************
C. PRINCIPAL'S CERTIFICATION
High School :________________________________________________ Address : ________________________________________________ TO WHOM IT MAY CONCERN:This is to certify that ___________________________ is a candidate for graduation this March2009. This further certifies that he/she belongs to the upper 20% of the graduating class numbering ____. ___________________________ Principal 
(Signature Over Printed Name)
 
Date: ________________________ 
FORM 2

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