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  • 4 CMO ANNEX B CHED Tulong Agri Application Form

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    Mutya, Rosemarie Kate N.
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    1) The document is an application form for the CHED Tulong-Agri Program (TAP), which provides financial assistance to qualified Filipino students pursuing degrees related to agriculture. 2) To qualify, applicants must be a Filipino citizen, graduating high school student or college student with at least a 75% GWA, and have a combined parental income not exceeding PHP 400,000 annually. 3) The form collects personal details of the applicant such as name, birthdate, address, contact information, as well as academic details and family background including parents' occupation and income.

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    1) The document is an application form for the CHED Tulong-Agri Program (TAP), which provides financial assistance to qualified Filipino students pursuing degrees related to agriculture. 2) To qualify, applicants must be a Filipino citizen, graduating high school student or college student with at least a 75% GWA, and have a combined parental income not exceeding PHP 400,000 annually. 3) The form collects personal details of the applicant such as name, birthdate, address, contact information, as well as academic details and family background including parents' occupation and income.

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    © All Rights Reserved
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    158 views1 page

    4 CMO ANNEX B CHED Tulong Agri Application Form

    Uploaded by

    Mutya, Rosemarie Kate N.
    1) The document is an application form for the CHED Tulong-Agri Program (TAP), which provides financial assistance to qualified Filipino students pursuing degrees related to agriculture. 2) To qualify, applicants must be a Filipino citizen, graduating high school student or college student with at least a 75% GWA, and have a combined parental income not exceeding PHP 400,000 annually. 3) The form collects personal details of the applicant such as name, birthdate, address, contact information, as well as academic details and family background including parents' occupation and income.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    of 1

    TAP Form

    ANNEX "B"
    2021 version (NOT FOR SALE)
    Office of the President of the Philippines
    COMMISSION ON HIGHER EDUCATION
    REGIONAL OFFICE V-B
    2X2
    ID PICTURE
    CHED TULONG-AGRI PROGRAM (TAP)
    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".

    GENERAL QUALIFICATION REQUIREMENTS: DOCUMENTARY REQUIREMENTS:


    Citizenship: Certified true copy of Birth Ceritificate
    1 Filipino citizen; Academic Requirements:
    2 Graduating high school student/high school graduate/with earned units in college; with general weighted High school report card for first year students eligible for college; or Duly certified true copy of grades for Grade 11 and 1st
    semester of Grade 12 for graduating senior high school studenr or duly certified true copy of grades for the latest
    average (GWA) of 75% or its equivalent; and who will enroll or currently enrolled in the areas of agriculture,
    semester/term attended for college students with earned units
    fisheries, forestry, food technology,veterinary medicine education, and other related agricultural and fishereis
    education including the hybrid programs Income Requirements - whichever is applicable :
    3 Combined annual gross income of parent/s or guardian which does not exceed Four Hundred Thousand Pesos Latest Income Tax Return of parent/s or guardian;
    (PhP400,000.00). Certificate of Tax Exemption from the BIR of parents/guardian, if not employed;
    Certificate of Indigence either from the Barangay or DSWD;
    Case Study from the Department of Social Welfare and Development; or
    NOTE: Applicant shall not be a recipient of any government-funded assistance. except for Free Higher Latest copy of contract or proof of income, for the children of Overseas Filipino Workers and seafarers.
    Education in SUCs and LUCs under RA 10931, the “UAQTE Act of 2017.”

    PERSONAL INFORMATION
    MUTYA ROSEMARIE KATE NASAYAO
    1. Name
    (Extension
    (Last Name) (First Name) (Middle Name)
    Name)
    2. Date of Birth (mm/dd/yy) 06/20/1999 PAG-ASA ST., BAYUIN, SOCORRO, ORIENTAL MINDORO
    9. Permanent Address
    (Street/Brgy., Town/City, Province)
    3. Place of Birth SOCORRO, ORIENTAL MINDORO

    4. Sex  Male ✓ Female 10. Zip Code 5207 11. District 1st

    ✓ Single  Widowed PAG-ASA ST., BAYUIN, SOCORRO, ORIENTAL MINDORO


    9. Current Address
    (Street/Brgy., Town/City, Province)
    5. Civil Status  Married  Separated

     Annulled  Others 10. Zip Code 5207 11. District 1st

    6. Citizenship FILIPINO 11. Name of School Last Attended MINDORO STATE UNIVERSITY

    7. Mobile Number 9984331525 12. School Address ALCATE, VICTORIA, ORIENTAL MINDORO

    8. E-mail Address [email protected]

    13. School Sector: ( )Public ( ✓ )Private 14. Learner Reference Number (LRN) NA
    15. Highest Attained Grade (Year Level) 4TH YEAR COLLEGE 16. Type of Disability (if applicable) NA

    17. IP affiliation (if applicable) NA


    FAMILY BACKGROUND
    Father: ( ✓) Living ( )Deceased Mother: (✓) Living ( ) Deceased Legal Guardian

    18. Full Name (including middle name) NESTOR MUTYA JR. JOSELYN MUTYA

    19. Address BAYUIN, SOCORRO, ORIENTAL MINDORO BAYUIN, SOCORRO, ORIENTAL MINDORO

    20. Contact Number 9092877134 9092877134

    21. Occupation LIVESTOCK DEALER HOUSEWIFE

    22. Name of Employer

    23. Employer Address

    24. Total Parents Annual Gross Income P 350,000.00

    25. Number of siblings 3


    26. School Intended to enroll or enrolled in: MINDORO STATE UNIVERSITY
    27. School Address: ALCATE, VICTORIA, ORIENTAL MINDORO
    28. Type of School: (✓) Public ( ) Private
    29. Degree Program: BS AGRICULTURAL AND BIOSYSTEMS ENGINEERING
    Type Grantee Institution/Agency
    30. Are you enjoying other sources of educational/financial assistance? ( ) Yes or ( ( )YES
    ) No (✓)NO If yes, please specify 1.____________ ____________________
    2.____________ ____________________
    I hereby certify that foregoing statements are true and correct. Any misinformation or witholding of information will automatically disqualify me from the Tulong-Agri Program.
    I hereby express my consent for the Commission on Higher Education to collect, record, organize, update or modify, retrieve, consult, use, consolidate, block, erase or destruct my personal data as part of my
    information. I hereby affirm my right to be informed, object to processing, access and rectify, suspend or withdraw my personal data and be indemnified in case of damages pursuant to the provisions of the Republic
    Act No. 10173 of the Philippines, Data Privacy Act of 2012 and its corresponding Implementing Rules and Regulations.

    ROSEMARIE KATE N. MUTYA 10/10/2021

    (Signature over Printed Name of Applicant) Date Accomplished


    Note: Fully accomplished form to be submitted to the CHEDRO
    DO NOT FILL-OUT THIS PORTION (FOR CHED USE ONLY)
    Documents Attached:
    1. Citizenship
    ( ) Certified true copy of birth certificate
    Belongs to: (any of the following groups) 2. Academic
    dependent of solo parent ( ) Copy of Grades ___________________
    senior citizens 3. Financial
    persons with disabilities please specify type of disability_________________ ( ) ITR ( ) Tax Exemption ( ) Certifcate of Indigency
    indigenous and ethnic peoples, please specify membership ____________________ ( ) Case Study DSWD ( ) OFW Contract
    4. Others
    ( ) Solo Parent ( ) Senior Citizen ( ) IPs ( ) PWD ( ) 4Ps
    Evaluated/Processed by:

    CHED StuFAP Coordinator

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