Republic of the Philippines

Office of the President

COMMISSION ON HIGHER EDUCATION
REGION X
Cagayan de Oro City

CHECKLIST OF REQUIREMENTS FORM

Reference: CHED Memorandum Order No. 13, S. 2014
Signed by Patricia B. Licuanan dated March 11, 2014
All certificates/affidavits should be in ORIGINAL COPIES.
(Please submit the checklist together with the requirements.)
Name of Applicant: (Surname, Given Name, Middle Name) Date Received: Application Tracking No.:
Roa N/A John Talaid 10-2-19-033914
Age: ____________ Sex: M F

I. ACADEMIC REQUIREMENTS
Incoming Freshman
Senior High School Graduate
Photocopy of Grades in Grade 12 and Original
Certificate of General Weighted Average (GWA)
from the Principal (minimum 75% or its equivalent
passing grade)
Candidate for Graduation in Senior High School
Photocopy of Grades in Grade 12 (1st Semester)
and Original Certificate of General Weighted
Average (GWA) from the Principal (minimum 75%
or its equivalent passing grade)
Photocopy of Grades in Grade 11 (1st and 2nd
LIVING
Semesters) and Original Certificate of General
Weighted Average (GWA) from the Principal
(minimum 75% or its equivalent passing grade)
BUKIDNON
For Children of Non-OFW, any one (1) of the following:
Latest Income Tax Return (ITR) of Parents or
Guardian (photocopy)
Certificate of Tax Exemption from the Bureau of
Internal Revenue (BIR)
Case Study from Department of Social Welfare and
Development (DSWD)
Affidavit of No Income
Certificate of Indigency from their Barangay
Certificate of Good Moral Character from the last school
C.
attended from the Guidance Counselor or Principal
III. ADDITIONAL REQUIREMENTS BELONGING TO THE FOLLOWING
PROGRAMS:

Accreditation and Equivalency Test Passer (ALS) Rebel Returnees/Integrees

Photocopy of Alternative Learning System (ALS) Authenticated Certificate from Office of the
Accreditation and Equivalency Test Presidential Adviser on the Peace Process (OPAPP)
Certificate/Certificate of Rating (Secondary Level) that the applicant is a bonafide rebel
from the Department of Education (DepEd)

Photocopy of Diploma from DepEd

Members of Indigenous and Ethnic Peoples
Philippine Educational Placement Text (PEPT) Passer Certification of membership either by the Office of
Photocopy of Certificate of Rating (Secondary Muslim Affairs or the National Commission on
Level) from the DepEd Indigenous Peoples

Photocopy of Diploma from DepED Solo Parents

Affidavit duly executed by the applicant that he/she is
With Earned Units in College a solo parent or a child of a solo parent with an
Photocopy of Grades in all subjects in completed attached Certification from a DSWD worker in the area
semesters and Certification of Total General
Weighted Average (GWA) in percentage from the
Registrar Certification of Good Moral Character of the PARENT
from the Barangay Chair of the place of domicile
Certification of good health of the APPLICANT
II. OTHER REQUIREMENTS Birth Certificate of the APPLICANT (photocopy)
ID of the SOLO PARENT (photocopy)
A. 2X2 ID Picture

B. Proof of Income (any of the following): Differently-Abled Persons (Persons with Disabilities)
For Children of Overseas Filipino Workers (OFW) and Certification from the DSWD
Seafarers, any one (1) of the following (photocopy):

Latest copy of contract Senior Citizens

Proof of Income Senior Citizen ID (photocopy)

Evaluation: Evaluated by: Date and Time:

With Complete and Correct Documents
with Deficiency/ies:

Signature Over Printed Name

Form Design Details:

Designed by Design Reveiwed by Design Approved by Rev. No. Date Modified Page

January 22, 2019

ENGR. ELMER C. LOPEZ NATHALIE T. IGOT RAUL C. ALVAREZ, JR., Ed.D, CESO III 1 1 of 1
ES II/StuFAPs Coordinator OIC, Office of the CEPs Director IV

ACKNOWLEDGEMENT RECEIPT (CLIENT'S COPY)

Name of Applicant: (Surname, Given Name, Middle Name) Evaluated by: Date and Time:

Roa John Talaid

Signature Over Printed Name

Evaluation: With Complete and Correct Documents Application Tracking No.: 10-2-19-033914