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Commission on the Higher Education (CHED)

and
Office of the Presidential Adviser on the Peace Process (OPAPP)
APPLICATION FOR OPAPP-CHED STUDY GRANT PROGRAM
A.

PERSONAL DATA OF FORMER REBEL OR MEMBER OF A GROUP WITH EXISTING PEACE


AGREEMENT WITH THE GOVERNMENT
Last Name________________________
First Name: _______________________
Middle Name: _____________________

Sex_____
Civil Status________________
Date of Birth: ______________________________
Place of Birth: _____________________________

B.

HOME ADDRESS OF FORMER REBEL OR MEMBER OF A GROUP


No./Street/Barangay: _________________________________________________________
City/Town, Province, Region: __________________________________________________
Res. Tel. No./Cellphone No:____________________________________________________

C.

PROFILE OF FORMER REBEL OR MEMBER OF A GROUP AND DEPENDENT SCHOLAR CANDIDATE

________________________________________________________________________________________________
C1. To be accomplished by the former rebel
or member of a group

C2. To be accomplished by former rebels or members


designated scholar candidate

Affiliation:

D.

CFPD (formerly CPLA)


CPP/NPA/NDF
MILF
MNLF
RPMP/RPA/ABB
Others, please specify______
For Former Rebels (FRs)only:
Date of Surrender: ________________________
Place: __________________________________

PERSONAL DATA
Last Name: ___________________________
First Name: ___________________________
Middle Name: _________________________
Sex: _____ Age: ______ Civil Status:_______
Date of Birth: _________________________
Place of Birth: _________________________
Relationship with the Former Rebel:________

Assistance Received from Government:


Immediate Assistance
Amount: ________
Livelihood Assistance
Amount: ________
Others: please specify ___________________

MAILING/RESIDENTIAL ADDRESS
No./ Street: ___________________________
City/ Town: ___________________________
Province: _____________________________
Region: ______________________________
Phone No: ____________________________

EDUCATIONAL BACKGROUND OF FORMER REBEL OR MEMBER OF A GROUP


AND DEPENDENT SCHOLAR CANDIDATE

D1. For Former Rebel or Member of a Group

D2. For the Designated Scholar Candidate

Elementary:
Name of School _________________________
Location/Place: __________________________
Year Graduated: _________________________

Elementary:
Name of School_______________________
Location Place: _______________________
Year Graduated: ______________________

High School:
Name of School: _________________________
Location/Place:__________________________
Year Graduated:_________________________

High School:
Name of School: _____________________
Location/Place: _______________________
Year Graduated: ______________________

College/University: (Where you intend to enroll)


Name of Institution: ______________________
Course: ________________________________
Year: __________________________________

College/University: (Where you intend to enroll)


Name of Institution: ___________________
Course: _____________________________
Year: _______________________________

WAIVER
(If the applicant is the next-of kin)
I, __________________________, a former rebel or
member of ______ of legal age hereby waive the
scholarship slot under the OPAPP-CHED Study Grant
Program in favor of Mr./Ms./Mrs._________________
who is my _________________, the same person who
filled-up this Application Form.
_______________________________________
Signature over Printed Name of Former Rebel/
Member of a group
Date: _____________________________

CERTIFICATION
This is to certify that all information given
to this application for OPAPP-CHED Study Grant
Program are true and correct, any misrepresentation
on any part shall be sufficient ground for this application
be denied. If chosen as a scholar, I will abide by the
Rules and Regulations set forth by the CHED and OPAPP.

_____________________________________
Signature over Printed Name of the Beneficiary
Date: _________________________________

SUBMITTED DOCUMENTS
Personal letter (designation of beneficiary)
Form 138 (High School Report Card)
Certification signed by the principal (if currently a 4th yr HS student)
Copy of Transcript of Records (if already earned units in college)
Authenticated copy of Marriage Contract ( if Applicant is spouse)
Authenticated copy of Birth certificate (if Applicant is the next-of-kin)
For Former Rebels (FR)
Copy of amnesty certificate, Military/ DND Authentication, Joint Validation and
Authentication Certificate (JVAC)
For individual members of group
Endorsement from the group and OPAPP- Program Management Office

1x 1
Picture of the
Applicant
Affix Signature on
the left side of the
picture

Right Thumbmark
(Applicant)