Office of the President of the Philippines

COMMISSION ON HIGHER EDUCATION

REGIONAL OFFICE ____

Female

Widowed

Separated

Others

No. of Siblings in the family

School Intended to enroll in

School Address:

Type of School: ( ) Public ( ) Private

Course: ( ) Priority ( ) Non-Priority

Documents Attached: Equivalent Points

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Evaluated/Processed by:

General Requirements: Documentary requirements:

1. 1.

2. 2.

3. 3.

4. 4.

5.

Name

Revised OSS FORM NO. 1

2012 version

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

(Last Name)

Duly certified High School Report Card for third year and grades for the first three grading

periods for fourth year:

(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)

Belongs to: (any of the following groups)

solo parent and their dependents

P

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;

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;

Certificate of good moral character from the high school principal/guidance counselor;

Must not be a recipient of any government scholarship and financial assistance.

CHED StuFAP Coordinator

Must be a Filipino citizen of good moral character; Accomplished CHED StuFAPs Application (OSS Form 01);

Must not be more than 30 years of age at the time of application except for senior citizens;

Total

Must be a high school graduate or a candidate for graduation;

Total Parents Gross Income

(First Name) (Middle Name)

Date of Birth (mm/dd/yy)

Father: ( ) Living ( ) Deceased Mother: ( ) Living ( ) Deceased

Occupation

Educational Attainment

Single

Married

Annulled

Male

Address

Sex

Civil Status

Place of Birth

indigenous and ethnic peoples

Latest ITR

No. of siblings in the family

Permanent Mailing

Address

Zip Code

School Name

FAMILY BACKGROUND

Name

School Type

Highest Grade/Year

( )Public ( )Private

School Address

E-mail Address Type of Disabilty (if applicable)

Citizenship

Mobile Number

Scholarship

Grants-In-Aid

Student Loan

Applicant is Qualified for:

senior citizens

persons with disabilities

Form 138

2 X 2 ID PICTURE