Revised OSS FORM NO.

1 2012 version

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

2X2 ID PICTURE

CHED STUDENT FINANCIAL ASSISTANCE PROGRAMS (StuFAPs) APPLICATION FORM

Instructions: Read General and Documentary Requirements. Fill in all the required information. Do not leave an item blank. If item is not applicable, indicate "N/A".

PERSONAL INFORMATION
Name (Last Name) Date of Birth (mm/dd/yy) Place of Birth Sex Civil Status (First Name) Permanent Mailing Address (Middle Name)

Male Single Married Annulled

Female Widowed Separated Others

Zip Code School Name School Address

Citizenship Mobile Number E-mail Address

School Type Highest Grade/Year

( )Public

( )Private

Type of Disabilty (if applicable)

FAMILY BACKGROUND
Father: Name Address Occupation Educational Attainment Total Parents Gross Income School Intended to enroll in School Address: Type of School: Course: ( ) Public ( ) Private ( ) Priority ( ) Non-Priority No. of Siblings in the family ( ) Living ( ) Deceased Mother: ( ) Living ( ) Deceased

(Signature over Printed Name of Applicant)

Date Accomplished

Note: Fully accomplished form to be submitted to the CHEDRO on or before March 31 DO NOT FILL-OUT THIS PORTION (FOR CHED USE ONLY) Applicant is Qualified for: Scholarship Grants-In-Aid Student Loan Belongs to: (any of the following groups) solo parent and their dependents senior citizens persons with disabilities indigenous and ethnic peoples Documents Attached: Form 138 Latest ITR No. of siblings in the family Total P = = = Equivalent Points

Evaluated/Processed by:

CHED StuFAP Coordinator General Requirements: 1. Must be a Filipino citizen of good moral character; 2. Must not be more than 30 years of age at the time of application except for senior citizens; 3. Must be a high school graduate or a candidate for graduation; 4. Must have a combined annual gross income of parents/guardian not to exceed Three Hundred Thousand Pesos (P300,000.00). For those who are exempted from filing income tax, there should be a certificate of tax exemption from the BIR. For OFW and Seafarers, a latest copy of contracr or prrof of income; 5. Must not be a recipient of any government scholarship and financial assistance. Documentary requirements: 1. Accomplished CHED StuFAPs Application (OSS Form 01); 2. Duly certified High School Report Card for third year and grades for the first three grading periods for fourth year: 3. Latest Income Tax Return (ITR), Certificate of Tax Exemption or Copy of Contract or proof of income of parents/guardian from Bureau of Internal Revenue; 4. Certificate of good moral character from the high school principal/guidance counselor;