STATEMENT OF ELIGIBILITY

Application for the SIKAP Grant

I, <<FullName>>, Filipino, <<Age>>, with permanent address at <<Complete Address>>,

after being sworn in accordance with law, hereby depose and state that:

1. I am applying for the grant under CHED Memorandum Order (CMO) No. 6, s. 2020
or the Guidelines for the Scholarships for Instructors’ Knowledge Advancement
Program (SIKAP) Grant;
2. I am employed as a Teaching Personnel in a Higher Education Institution (HEI), OR
have been employed as a Teaching Personnel within the last twelve (12) months, at
the time of application; (accomplish table, as applicable)

If employed:

Type Institution/s of Rank1 Status Length of

(Check all that apply) Employment (Full-time, Part- Service
time) (e.g. __ Years
and __ Months)

❏ Employed 1.

Choose one:
❏ Single
Employment 2. (Add more rows
❏ Multiple if necessary)
Employment

❏ Self-
Employed

❏ Others

If unemployed:

HEI of Previous Employment <<Name of Institution>>

Rank Length of Service

(e.g. __ Years and __ Months)

Date of Reason for

Separation Separation

3. I am not currently holding a top or middle level administrative or management

position in any government agency or private company;
4. I am not currently holding or have not held a full-time work in any government
agency, or private company, which are not HEIs (e.g. State and Local Universities
and Colleges, Private HEIs, etc);
1 Professor, Associate Professor, Instructor, Lecturer, Guest Lecturer, Dean, Director, Registrar etc
 5. I am applying for (check box of appropriate answer):
❏ Full-time scholarship: I shall ensure and commit to pursue the degree
program on full-time study;
❏ Part-time scholarship: I shall ensure and commit to have a maximum of
twelve (12) units of teaching load, or twenty (20) hours of work per week, in
no case greater than any of the two conditions;
6. In the event that I will hold a full-time or part-time employment, I shall disclose all
such other forms of employment to the Commission, subject to compliance with the
grant-specific restrictions on concurrent employment during the period of the grant.
Further, the non-disclosure shall warrant grant-specific restrictions and sanctions on
concurrent employment during the period of the grant;
7. For the Individual Model, I have been admitted to an eligible graduate program;
8. For the Delivering HEI Model, I have submitted my documents to the DHEI, as part of
the admissions process;
9. I shall pursue a program vertically articulated to my teaching discipline, and I
currently do not hold a degree level being pursued, unless otherwise allowed through
the proper exemptions;
10. I am of age that will allow me to render sufficient return service after obtaining my
graduate degree, unless otherwise allowed through the proper exemptions;
11. I currently do not have any other government-funded scholarship or grant;
12. I am committed to complete the degree program requirements within the study
duration;
13. I do not have, up to the fourth (4th) degree of consanguinity or affinity, to any CHED
employee in the CHED Regional Office (CHED RO) where the application is being
processed2;
14. I am cognizant, willing, and accepting of this commitment, and the various terms and
conditions of this grant as stipulated in the CMO No. 6, s. 2020 and all relevant
CMOs and shall comply with the same, and
15. I fully understand the consequences of not giving correct and truthful data and I am
aware that non-disclosure of material information as required by CMO No. 6, s. 2020
will put me under the pain of perjury by executing this document.

WHEREFORE, in order to attest to the truth of the foregoing, I hereby affix my signature to
this Certification this ___ day of (Month), 2020 in (City/Municipality).

___________________________

Signature over printed name

SUBSCRIBED AND SWORN to before me, this __ day of ___ 2020 at _______, Philippines.

<<NOTARY>>

2 Based on the Administrative Code of 1987, Executive Order No. 292 and SC Memorandum Circular
No. 21, s. 2004