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Full Time Sikap Statement of Eligibility

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STATEMENT OF ELIGIBILITY

Application for the Full-Time Study under the SIKAP Grant

I, <<Full Name>>, Filipino, <<Age>>, with permanent address at <<Complete Address>>,


after being sworn in accordance with law, hereby depose and state that:

1. I am applying for the FULL-TIME STUDY UNDER SIKAP GRANT (CMO No. 16, s.
2021) or the Revised Guidelines of CMO No. 06, s. 2020 for Full-Time SIKAP Grant
Scholars;
2. I am employed as a Teaching or Non-Teaching Personnel in a Higher Education
Institution (HEI), OR I have been employed as a Teaching or Non-Teaching
Personnel within the last twelve (12) months, at the time of application; (accomplish
table, as applicable)

If employed:

Type Institution/s of Rank1 Status Length of


(Check all that apply) Employment (Full-time, Part- Service
time) (e.g. __ Years
and __ Months)

❏ Employed 1.

Choose one:
❏ Single
Employment 2. (Add more rows
❏ Multiple if necessary)
Employment

❏ Self-
Employed

❏ Others

If unemployed:

HEI of Previous Employment <<Name of Institution>>

Rank Length of Service


(e.g. __ Years and __ Months)

Date of Reason for


Separation Separation

1 Professor, Associate Professor, Instructor, Lecturer, Guest Lecturer, Dean, Director, Registrar etc
3. If holding a position in the Top, Middle, and First-Line Management in the HEI/s
where I am connected, I shall submit an approved study leave for full-time study from
the start of the scholarship and for the duration of study or, an issued certification of
deloading of teaching units/work responsibilities;
4. I am of age (not more than 50 years old) that will allow me to render sufficient return
service after obtaining my graduate degree and impart my acquired degree to the
higher education sector;
5. I am physically fit and mentally prepared to undertake and complete graduate work
as supported by a medical certificate;
6. I am admitted or will enroll in a graduate degree program identified in the Scope and
Coverage of the CMO No. 16, s. 2021;
7. I am not currently holding a full-time work in any government agency, or private
company, which are not HEIs (e.g. State and Local Universities and Colleges, Private
HEIs, etc);
8. I currently do not hold a degree in the degree level being pursued (i.e. applicants for
a scholarship for doctorate degree, must not already possess a doctorate degree);
9. I currently do not have any other government-funded scholarship or grant;
10. I am committed to complete the degree program requirements within the study
duration;
11. I shall disclose to the Commission if I have a relationship, up to the fourth (4th)
degree of consanguinity or affinity, with any CHED employee in the CHED Regional
Office (CHED RO) where the application is being processed;
12. I am cognizant, willing, and accepting of this commitment, and the various terms and
conditions of this grant as stipulated in the CMO No. 16, s. 2021 and all relevant
CMOs and shall comply with the same, and
13. I fully understand the consequences of not giving correct and truthful data and I am
aware that non-disclosure of material information as required by CMO No. 16, s.
2021 will put me under the pain of perjury by executing this document.

WHEREFORE, in order to attest to the truth of the foregoing, I hereby affix my signature to
this Certification this ___ day of (Month), 2022 in (City/Municipality).

___________________________

Signature over Printed Name

SUBSCRIBED AND SWORN to before me, this __ day of ___ 2022 at _______, Philippines.

<<NOTARY>>

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