Reap Rs Template Final
Reap Rs Template Final
Reap Rs Template Final
(Local Scholarship)
- and -
WITNESSETH:
In line with CHED Memorandum Order No. 3, series of 2016, and for and in
consideration of the actual financial support for the duration of the scholarship benefits which
will be released to the NOMINEE contingent upon his/her acceptance to the GRADUATE
SCHOLARSHIP FOR FACULTY AND STAFF UNDER THE CHED K TO 12 TRANSITION
PROGRAM and the DHEI, the SHEI shall allow the NOMINEE to pursue studies on a full-time
basis leading to _________(Degree and Program)__ _____ at the _________(DHEI)_______
for a duration of _____ Semester(s)/Trimester(s)/Quarter(s) commencing on First Semester AY
2016-2017 subject to the following terms and conditions:
SHEI NOMINEE
_____________________ _____________________
President/Head Faculty
Witness Witness
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Annex A
Degree Program
Name and Address of HEI where applicant is currently employed where return service will
SHEI be rendered
Describe the nature of your employment under the Sending HEI following
Designation/Status
completion of the degree.
What are the current needs, gaps, challenges and opportunities in your
Sending HEI / discipline / region / country that you will be able to help
Context
address by earning this degree and undertaking further studies?
Give three objectives you intend to accomplish upon earning your degree
and undertaking further studies in terms of contribution to your sending HEI
/ discipline of study / region / country.
Objectives
Objectives must be specific, measurable, achievable, relevant and time-
bound (SMART).
__________________________ __________________________
Signature of Applicant Date
I hereby certify that the above information is true and correct, and that
___(Name of University)___ has committed to the above reentry plan for
____ (Name of Applicant)_______.
______________________________ ______________________________
Name and Signature of Dean Name of School/College in SHEI
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ACKNOWLEDGMENT
Valid ID/Passport
Name Date & Place Issued
Number
(NOMINEE)
Notary Public
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