Form 1 App.

No: 2020-05-22 684496O

Office of the President of the Philippines
COMMISSION ON HIGHER EDUCATION
REGIONAL OFFICE V

CHED SCHOLARSHIP PROGRAMS (CSPs)

APPLICATION FORM

PERSONAL INFORMATION
Name LORETCHA None Jovie Malaca
(Last Name) (First Name) (Middle Name)
Date of Birth 2001-09-12 Street/Barangay Bagalayag Castilla Sorsogon City
Place of Birth Bagalayag Castilla Sorsogon City Town Sorsogon City
Sex Female Province Sorsogon
Civil Status Single District 1st
Contact No. 09484743922 Zip Code 4700
Email Loretchajovie@gmail.com
FAMILY BACKGROUND
FATHER ( ✔ ) Living ( ) Deceased MOTHER ( ✔ ) Living ( ) Deceased
Name NONE None None None Name NONE None None
Address None Address None
Educational Attainment None Educational Attainment None
Occupation None Occupation None
LEGAL GUARDIAN
Name MALACA Yolanda Loretcha None No. of Siblings 3
Address Parent(s)/Guardian Annual Gross Income P 20.00
Occupation DSWD's 4ps Beneficiary ( ) YES ( ✔ ) NO
ACADEMIC INFORMATION
Applicant Type A-HS Graduate Year Level in 2020-2021 1
High School Graduated Computer Communication Learner Reference Number 114099060012
Development Institute
College ACLC College of Sorsogon General Weighted Average 85
Degree Program/Course Bachelor of Science in Hotel and Restaurant Management
Are you enjoying other source of educational/financial assistance? ( ) YES ( ✔ ) NO
If YES, please specify Type Agency
OTHERS
YES NO
✔ Indigenous and Ethnic People (IP), please specify membership
✔ Dependent of Solo Parent
✔ Persons with Disabilities (PWDs), please specify type of disability

I hereby certify that foregoing statements are true and correct. Any misinformation or witholding of information will automatically disqualify me from the CHED
Scholarship Program. I am willing to refund the financial benefits received if such information is discovered after acceptance of the award.

I hereby express my consent for the Commission on Higher Education to collect, record, organize, update or modify, retrieve, consult, use, consolidate, block, erase
or destruct my personal data as part of my information. I hereby affirm my right to be informed, object to processing, access and rectify, suspend or withdraw my
personal data and be indemnified in case of damages pursuant to the provisions of the Republic Act No. 10173 of the Philippines, Data Privacy Act of 2012 and its
corresponding Implementing Rules and Regulations.

May 22, 2020 JOVIE M. LORETCHA

Date Accomplished (Signature over Printed Name)

DOCUMENTS ATTACHED REMARKS

1. Citizenship
( ) Duly certified true copy of Birth Certificate

2. Academic
( ) Duly certified true copy of Report Card - For SH/HS
Graduate
( ) Duly certified true copy of Grades: Grade 11 and 1st
semester of Grade 12 - For Graduating Senior HS

3. Financial
( ) Income Tax Return ( ) Tax Exemption
( )Certificate of Indigency ( ) Case Study
( )OFW Contract

4. Others
( ) Solo Parent ( ) Senior Citizen
( ) IPs ( ) PWD

Evaluated/Processed by

__________________________________ ________________________________
CHED StuFAPs Coordinator Date
 Office of the President of the Philippines
COMMISSION ON HIGHER EDUCATION
REGIONAL OFFICE V

CHED SCHOLARSHIP PROGRAMS (CSPs)

ACKNOWLEDGEMENT RECEIPT

LAST NAME FIRST NAME MIDDLE NAME

LORETCHA NONE JOVIE MALACA

ADDRESS
BAGALAYAG CASTILLA SORSOGON CITY, SORSOGON CITY, SORSOGON, 4700

OPY
DATE OF BIRTH PLACE OF BIRTH SEX CIVIL STATUS
SEPTEMBER 12, 2001 BAGALAYAG CASTILLA
SORSOGON CITY
' S C FEMALE SINGLE

COLLEGE
ACLC COLLEGE OF SORSOGON
U D ENT DEGREE PROGRAM/COURSE
BACHELOR OF SCIENCE IN HOTEL AND RESTAURANT

APPLICATION ENTRY DATE

ST
APPLICATION NUMBER
MANAGEMENT

GWA FAMILY GROSS ANNUAL INCOME

MAY 22, 2020 2020-05-22 684496O 85 P 20.00

_________________________ ____________________
Received By Date Received

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CSP NOTICE:
CSP applicants are advised to wait for the rank list of the pre-qualified applicants which will be posted at the CHEDROV CSP Official
Website: www.chedro5stufap.com after the application period. Only the pre-qualified applicants based on the rank-list and the
available slots will be required to submit the hard copies of documentary requirements for verification and issuance of Notice of
Award (NOA).

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