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CMWSP Evaluation Form

OWWA evaluation form for congressional migrant workers scholarship program

Your Browser Doesn't Support Canvas. Showing the Text Content of the PDF Instead: 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.
6.
7.
8.
9.

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Secondary School Record (Form 137)
Form 2A - Health Certificate
Form 2B - Certificate of Good Moral Character
Form 2C - Certification that applicant belongs to the upper 20% of the High School Graduating Class
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: _________________________________

APPROVED:

OWWA Regional Welfare Office Director

Date

FORM 1

Republic of the Philippines
Department of Labor and Employment

Application No._______________

NOT FOR SALE
(can be reproduced)

Overseas Workers Welfare Administration

Regional Welfare Office ________
PROGRAM SERVICES DIVISION

CMWSP
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 _____________________
FATHER

12. PARENTS’ INFORMATION

MOTHER

a. Name:

_____________________________________________________

_________________________________________

b. Citizenship:

_____________________________________________________

_________________________________________

c. Highest Education Attained:

_____________________________________________________

_________________________________________

d. Tribal Affiliation (if any):

_____________________________________________________

_________________________________________

e. Occupation:

_____________________________________________________

_________________________________________

f. Employer Address:

_____________________________________________________

_________________________________________

g. Gross Income:

No. of Siblings in the Family : _______ Family Order : 1 st [ ] 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:

Parent / Guardian
(Signature Over Printed Name)

Applicant
(Signature Over Printed Name)
Date: __________________________

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
(Signature Over Printed Name)

___________________________
Applicant
(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
citizenship and has no pending application for immigration to any country.

not a holder of dual

_______________________
Parent / Guardian
(Signature over Printed Name)
 
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