Republic of the Philippines

Department of Labor and Employment

Overseas Workers Welfare Administration

Regional Welfare Office ______

Program Services Division

Congressional Migrant Workers Scholarship Program (CMWSP)

EVALUATION FORM

A. APPLICANT’S DATA
Name ______
Last First Middle
Age:___ Birthdate:______Citizenship______Sex: M [ ] F [ ]
Relationship to OFW ______Tel.No ______
Preferred Course:______
Preferred School:______/ B. OFW DATA:
Name of OFW : ______
Last First Middle
Occupation/Jobsite : ______
Category: LB [ ] SB [ ] SEX: M [ ] F [ ]
Civil Status: S[ ] M [ ] Region: ______
Latest Date of OWWA Contribution : ______
Term of Contract: ______
C. REQUIREMENTS
1. [ ] Application Form
2. [ ] Two (2) 2” x 2” recent & Identical Photos
3. [ ] Proof of OWWA Membership
__ Official Receipt of OWWA Contribution
__ OFW Verification Sheet issued by MPC
4. [ ] Proof of Relationship to OWWA-Member/OFW
__ Birth Certificate (issued by NSO) of applicant, if child of OFW
__ Birth Certificate (issued by NSO) of applicant / OFW
5. [ ] Secondary School Record (Form 137)
6. [ ] Form 2A - Health Certificate
7. [ ] Form 2B - Certificate of Good Moral Character
8. [ ] Form 2C - Certification that applicant belongs to the upper 20% of the High School Graduating Class
9. [ ] Form 2D - Applicant’s Certificate of not having taken post secondary or undergraduate/ college units
and not a Recipient of any scholarship grant / has not taken the EDSP Qualifying Examination
10.[ ] Form 2E - Sworn Statement that applicant has no pending application for resident immigrant status
from any country & does not have dual citizenship
D. ALTERNATE/OTHER REQUIREMENTS :
______
______
______
Received by: ______
Date: ______
Evaluated by: ______
Head, Education and Training Unit
Date: ______/ Recommending Approval:
______
Chief, Programs Services Division
Date: ______
FORM 1
Application No.______ /
NOT FOR SALE
(can be reproduced)
Republic of the Philippines
Department of Labor and Employment

Overseas Workers Welfare Administration

Regional Welfare Office ______

PROGRAM SERVICES DIVISION

Congressional Migrant Workers Scholarship Program (CMWSP)

APPLICATION FORM

I. INFORMATION SHEET (Note: Please PRINT LEGIBLY)

1. Name: ______2. Age___ 3. Birthdate ______4. Sex: F [ ] M [ ]
LAST FIRST MIDDLE
5. Permanent Address: ______6. Civil Status______
Municipality / District: ______Zip Code: ______7. Citizenship______
8. High School Attended: ______9. Tel No. ______
10. School Address : ______Mobile No.______
11.Gen. Average in 4th Year High School ______
12. PARENTS’ INFORMATION
a. Name:
b. Citizenship:
c. Highest Education Attained:
d. Tribal Affiliation (if any):
e. Occupation:
f. Employer Address:
g. Gross Income: / FATHER
______
______
______
______
______
______/ MOTHER
______
______
______
______
______
______

No. of Siblings in the Family : ______Family Order : 1st [ ] 2nd [ ] 3rd [ ] Others: ______

I hereby certify that all answers given above are true and correct to the best of my knowledge. I will also abide with the policy of the program that selection of qualified examinees for scholarship award after approval of the Administrator is final and unappealable.

Attested by:

FORM 2

A. HEALTH CERTIFICATE

HEALTH AGENCY : ______

ADDRESS : ______

______

DATE: ______

TO WHOM IT MAY CONCERN:

This is to certify that I have examined ______

and found him/her to be:

Physically fit

Physically unfit

for scholarship application.

This certification is issued in connection with his/her application for the Congressional Migrant Workers Scholarship Program (CMWSP) for the SY 2014 - 2015.

______

Medical Officer

(Signature Over Printed Name)

LC # ______

B. CERTIFICATE OF GOOD MORAL CHARACTER

This is to certify that ______is of good moral character and that no disciplinary action has been taken against him/her as of date.

______

Principal / Guidance Counselor

(Signature Over Printed Name)

C. PRINCIPAL'S CERTIFICATION

High School : ______

Address : ______

TO WHOM IT MAY CONCERN:

This is to certify that ______is a candidate for graduation this March 2014. This further certifies that he/she belongs to the upper 20% of the graduating class numbering ____.

______

Principal (Signature Over Printed Name)

D. APPLICANT'S CERTIFICATION

TO WHOM IT MAY CONCERN:

This is to certify that the undersigned has not previously taken the Congressional Migrant Workers Scholarship Program (CMWSP) Qualifying Examination and any post secondary/ vocational or undergraduate/college units.

Attested by:

______

Parent / Guardian Applicant

(Signature Over Printed Name) (Signature Over Printed Name)

E. PARENT'S CERTIFICATION ON APPLICATION

FOR IMMIGRATION / DUAL CITIZENSHIP OF APPLICANT

TO WHOM IT MAY CONCERN:

This is to certify that my son / daughter ______is not a holder of dual citizenship and has no pending application for immigration to any country.

______

Parent / Guardian

(Signature over Printed Name)