OSS-CHED SCHOLARSHIP FORM NO.

Office of the President of the Philippines

COMMISSION ON HIGHER EDUCATION
Higher Education Regional Office ____

2X2
ID PICTURE

SCHOLARSHIP APPLICATION FORM

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
PESFA
SSP
NISGP (Tribe)
SEGEAP (Tribe)

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

SNPLP
OPAPP-CHED Study Grant Program for Rebel Returnees
CHED NPUD for MNLF
Others (pls. Specify)

PERSONAL INFORMATION

Received by Authorized Offici

Printed Name & Sig

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 Secondary Achievement Test (NSAT) Score:
Academic Awards/Honors Received:
SCHOOL
NATURE/DESCRIPTION

(Middle Name)
Citizenship:
Telephone Number:

Rank in Class:
Date of Exam:
DATE

FAMILY BACKGROUND
Father
( ) Living
( ) Deceased
Name:
Address:
Occupation:
Educational Attainment:
Tribe Membership (for NISGP & SEGEAP only):
Authenticated certificate from OPAPP (OPAPP-CHED SGP-RR only)
Total Parents Gross Income:
Brothers/Sisters Enjoying Scholarship:
Name:
Scholarship

Mother:

Living

(ITR for 200____ attac

Course and

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 :

CERTIFICATION
This is to certify that

from the Province of

Congressional District
has been awarded a study grant/loan assistance
by the Commission on Higher Education through the CHEDRO
to

enroll at
effective School Year

(Printed Name Over Signature of Applicant)

Note: Fully accomplished form to be submitted to thed CHEDRO on or befor April 30

Date

2
URE

cial
gnature)

Deceased

ched)
d Year