Scribd Logo
Upload

Welcome to Scribd!

  • 39 views

    Date Accomplished (Signature Over Printed Name) : 1. Citizenship

    Uploaded by

    Jansen Tan
    The document is an application form for CHED scholarship programs. It contains personal information about the applicant such as name, date of birth, address, family background, academic information including high school and college details, and a certification and consent for personal data collection. Required documents like birth certificate, academic records, and financial documents are also listed.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Date Accomplished (Signature Over Printed Name) : 1. Citizenship

    Uploaded by

    Jansen Tan
    39 views2 pages
    The document is an application form for CHED scholarship programs. It contains personal information about the applicant such as name, date of birth, address, family background, academic information including high school and college details, and a certification and consent for personal data collection. Required documents like birth certificate, academic records, and financial documents are also listed.

    Original Title

    2020-05-13_066534O-1.pdf

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    The document is an application form for CHED scholarship programs. It contains personal information about the applicant such as name, date of birth, address, family background, academic information including high school and college details, and a certification and consent for personal data collection. Required documents like birth certificate, academic records, and financial documents are also listed.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    39 views2 pages

    Date Accomplished (Signature Over Printed Name) : 1. Citizenship

    Uploaded by

    Jansen Tan
    The document is an application form for CHED scholarship programs. It contains personal information about the applicant such as name, date of birth, address, family background, academic information including high school and college details, and a certification and consent for personal data collection. Required documents like birth certificate, academic records, and financial documents are also listed.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    Form 1 App.

    No: 2020-05-13 066534O


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

    CHED SCHOLARSHIP PROGRAMS (CSPs)


    APPLICATION FORM
    PERSONAL INFORMATION
    Name SURIO Archie Archie Ching
    (Last Name) (First Name) (Middle Name)
    Date of Birth February 10, 2000 Street/Barangay Catangcas Street, Barangay 5
    Place of Birth Pambujan Northern Samar Town Pambujan
    Sex Male Province Northern Samar
    Civil Status Single District 2nd
    Contact No. 09098292316 Zip Code 6413
    Email [email protected]
    FAMILY BACKGROUND
    FATHER ( ✔ ) Living ( ) Deceased MOTHER ( ✔ ) Living ( ) Deceased
    Name SURIO Charlie Tuballas Ano Name CHING Rona Petalbo
    Address Pambujan Norther Samar Address Pambujan Norther Samar
    Educational Attainment College Graduate Educational Attainment College Graduate
    Occupation Regular Occupation Maid
    LEGAL GUARDIAN
    Name SURIO Charlie Tuballas Rona No. of Siblings 4
    Address Parent(s)/Guardian Annual Gross Income P 5,000.00
    Occupation DSWD's 4ps Beneficiary ( ) YES ( ✔ ) NO
    ACADEMIC INFORMATION
    Applicant Type A-HS Graduate Year Level in 2020-2021 1
    High School Graduated Pambujan National High School Learner Reference Number 123182060301
    College UNIVERSITY OF EASTERN PHILIPPINES - MAIN General Weighted Average 84
    Degree Program/Course Bachelor of Science in Environmental Science
    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 13, 2020 ARCHIE C. SURIO ARCHIE


    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 VIII

    CHED SCHOLARSHIP PROGRAMS (CSPs)


    ACKNOWLEDGEMENT RECEIPT

    LAST NAME FIRST NAME MIDDLE NAME


    SURIO ARCHIE ARCHIE CHING

    ADDRESS
    CATANGCAS STREET, BARANGAY 5, PAMBUJAN, NORTHERN SAMAR, 6413

    OPY
    DATE OF BIRTH PLACE OF BIRTH SEX CIVIL STATUS
    FEBRUARY 10, 2000 PAMBUJAN NORTHERN
    SAMAR
    ' S C MALE SINGLE

    COLLEGE

    U D
    UNIVERSITY OF EASTERN PHILIPPINES - MAIN ENT DEGREE PROGRAM/COURSE
    BACHELOR OF SCIENCE IN ENVIRONMENTAL SCIENCE

    APPLICATION ENTRY DATE


    MAY 13, 2020
    ST
    APPLICATION NUMBER
    2020-05-13 066534O
    GWA
    84
    FAMILY GROSS ANNUAL INCOME
    P 5,000.00

    _________________________ ____________________
    Received By Date Received

    Powered by TCPDF (www.tcpdf.org)

    You might also like