Republic of the Philippines Department of Education REGIONI SCHOOLS DIVISION OFFICE I PANGASINAN DIVISION MEMORANDUM ] pM.No._PYs. 2024 peteaten iH i DEPED To $00 Personnel mente Public and Private School Heads APR 2 0 2021 Teaching and Non-Teaching Personnel sp0-Recnens All Others Concerned eK FROM: ‘THE OFFICE OF THE SCHOOLS DIVISION SUPERINTENDENT SUBJECT: POLICIES AND GUIDELINES AND APPLICATION FORMS FOR THE PROVINCIAL SCHOLARSHIP PROGRAM (PSP) FOR ACADEMICALLY- HIGHLY COMPETENT COLLEGE STUDENTS FOR A.Y. 2021-2022 DATE: April 20, 2021 PARTICULARS 41. With reference to the attached Letter Circular No. 2021-0067 of the Provincial Government of Pangasinan on Policies and Guidelines and Application Forms for the Provincial Scholarship Program (PSP) for Academically-Highly Competent College Students for A.Y. 2021-2022, this office informs the field regarding this matter. 2. Please see attachments for further details. 3. For the information and guidance of all concerned. ELY S, UBALDO, CESO Vy. Assistant Schools Division Superintendent Officer-In-Charge Office of the Schools Division Superintendent PROVED. FOR TRANSHISSION ‘Address:Alvear St. East Capitol Grounds, Document Code: SD01P-FROOL LUngayen, Pangasinan Beh wevsionnos01 Telephone No :(075)-522-2202 Net 5 page No.: Page Loft Emaiipangasinant@deped.gov.ph effectivity Date: 12-09-2019Republic of the Philippines Province of Pangasinan Office of the Governor Capitol Compound, Lingayen, Pangasinan Telefax: (075) 542-2368 Admin O917-3114144 EAIV: 0920°916-€016/0918-948-4565 EAM! 0917-596-9282/ 0933-812-8897 Email, pgoadmz0tS@gmal.com HON. AMADO I. ESPINO III Governor April 12, 2021 LETTER CIRCULAR NO. 2021-0067 To + All City/ Municipal Mayors All DepEd Schools Division Superintendents All City! Municipal Liga ng mga Barangay Presidents and ‘Sangguniang Kabataan Presidents Province of Pangasinan FROM : GOVERNOR AMADO |. ESPINO III SUBJECT : APPLICATION FORM FOR THE PR¢ ICIAL SCHOLARSHIP PROGRAM (PSP) FOR ACADEMICALLY-HIGHLY COMPETENT COLLEGE STUDENTS FOR A.Y. 2021-2022 Transmitted herewith are copies of the Policies and Guidelines and Application Forms for the Provincial Scholarship Program (PSP) for Academically Highly Competent (AHC) College Students for A.Y. 2021-2022. In view hereof, all City/ Municipal Local Chief Executives, Schools Division Superintendents, and City/ Municipal Liga ng mga Barangay Presidents and Sangguniang Kabataan Presidents are hereby directed to cause the widest dissemination of information regarding the application for said scholarship program. Requirements: 1. Senior High School Fourth Grading (Final) Report Card with General Weighted Average (GWA) of 85% or higher (Certified Photocopy by the Class Adviser) 2. Regular Medical Certificate from a licensed physician (Original Copy) 3. Social Case Study Report from the Municipal/City Social Welfare & Development Office(Original Copy) 4. PSP Academic Scholarship Application Form (PSP Form No. 1) 5. Certificate of Scholarship Eligibility/ Good Moral Character (PSP Form No. 2) 6. Individual information Sheet (PSP Form No. 3) with recent picture. (Taken within the last six (6) Months) Al applicants shall follow the one-time submission of complete application requirements either through email: pangskolar2021@gmail.com or personal for those who live near the provincial Capitol. Deadline of submission of scholarship application requirements is on July 20, 2021 For further inquiries, please coordinate with Mr. Henry Cruz, 0917-116-3890 or Ms. Ann Calimiim, (0917-311-4144, Please be guided accordingly A uk i; AMBISY@N a AMEISVONRepublic of the Phiippines PROVINCE OF PANGASINAN E i OFFICE OF THE GOVERNOR Lingayen PROVINCIAL SCHOLARSHIP PROGRAM (PSP) POLICIES AND GUIDELINES FOR ACADEMIC SCHOLARS A.Y. 2021-2022 ARTICLE | ‘The Scholarship Offering ‘Section 1. General Description. The Provincial Scholarship Program (PSP) consists of financial assistance from the Provincial Government ‘of Pangasinan for the college education of financially-challenged but deserving graduating high school students, ‘Section 2. College Education, what it consists of. College education consists of completion of work, leading to any four-year or five-year Bachelor's degree in any government recognized institution of higher leaming in the country. ‘Section 3. Financial Assistance, what it consists of. The amount of ten thousand pesos (P10,000. 00) every term or semester, i.e. twice ‘every academic year, shall be given as financial assistance to the scholar. Ifthe receiving school adopts a trimester program, the ‘assistance is given at the first and the third trimester. The basis of computation would be the General Weighted Average (GWA) of the firs trimester and the sum of the GWA of the second and thi trimesters. ‘Section 4. Standard for maintaining scholarship benefits. Par. a.) Every scholar, must, in every semester of schooling, maintain (1) a ful, normal load. Full normal load is the required ‘number of units to be enrolled by the scholar every semester as provided for by his/her school's course curriculum; (2) a GWA of eighty-five percent (85%), with no grade below eighty percent (80%) in all academic and non-academic subjects, Par. b.) In highly technical courses like Engineering, Architecture, and Accountancy, a GWA of eighty-two percent (82%), with no {ailing grade in any subject, shall suffice in order to be entitled to the same scholarship benefits for the ensuing eemester. Par. c.) Failure to meet the foregoing standards for any reason terminates the scholarship assistance. ‘Section 5. Effects of other scholarship grants/ assistance. Par. a.) The scholar who is able to earn academic scholarship or some other kind of educational benefits or privileges from the ‘school itself, or other private sources, shall sil continue to receive financial assistance from the provincial government of Pangasinan. Where the scholar is a recipient of the Free Tertiary Education benefits for State Colleges and Universities, he/she shall continue to receive the scholarship assistance. Par. b.) The scholar shall be disqualified to receive scholarship assistance, if he/she receives from the government another scholarship assistance other than the Free Tertiary Education package in which case the scholar will have to choose ‘between the PSP Academic Scholarship or the scholarship coming from anather government agency, Par.c.) When a scholarship slot is vacated or waived, the PSP Management, Evaluation and Excellence Committee (PSPMEEC) reserves the right to give itto the applicant who is next in rank, based on the qualification standard. This applies to First ‘Year scholars only ARTICLE It The Selection Criteria ‘Section 1. Qualified Applicants. The following can apply for the scholarship assistance Par a.) He/She should have a General Weighted Average (GWA) of eighty-five percent (85%) or higher. Par b.) He/She should be a graduating Senior High School student of a recognized secondary school by the Department of Education. ¢,) He/She should belong to an indigent family as indicated by a Social Case Study Report from the DSWD, Par d.) He/She should present a certificate of good moral character (PSP Form 2). ar 0.) He/She should present a medical certificate attesting to his/her good health, ar f.) He/She should be a resident of Pangasinan for at least one (1) year, except Dagupan City ARTICLE I Forfeiture of Benefit ‘Section 1. The scholar will lose his/her scholarship in any of the foliowing: Par. a.) When helshe fails to meet the grade requirement. Par. b.) When he/she fails to enroll during the term or semester he/she is qualified. Par. c.) When helshe, for any reason, siops schooling for one (1) term or one (1) semester. ar. d.) When he/she fails to submit his her grade requirements for one (1) term or one (1) semester ar. e.) When helshe avails of another government scholarship assistance other than the Free Tertiary Education package. Section 2. Exemption. A scholar who is disqualified to pursue highly competitive quota courses but has passed the maintaining grade Requirement of the Provincial Scholarship Program (PSP) may shif to a related course in the same school, subject however to the Provincial Scholarship Program Management, Evaluation and Excellence Committee (PSPMEEC's) review and approval. ARTICLE IV ‘Submission of Application Requirements Section 4, All applicants should comply with the one-time submission of complete scholarship application requirements either through ‘email: pangskolar2021@gmail.com or personally at the 1* Floor Capitol Building, Lingayen, Pangasinan. Section 2, Deadline of submission of complete scholarship application requirements for A.Y. 2021-2022 is on July 20, 2021. ARTICLE V Qualification Standard Seotion 1. For A.Y. 2021-2022, due to the challenges of the pandemic, the selection for the two hundred ten (210) available slots will be based Con the following formula: Population of Municipality! Cay “Total No, of Scholarenip No.of slots R x "Slots Available = perMunicipaltyity Grand Total No. of Population of Pangasinan in 2015 Cee aan SEINE neice ‘Annlirstinn Eaves mau ha ranrnuirer rane 1 of 3 (April 2021)PsP rom 4 ePUBLC OF THE PUPPIES a DROVINCE OF PANGASINAN (ee ; Uneven PSP ACADEMIC SCHOLARSHIP APPLICATION FORM | wish to apply for college scholarship assistance and enroll at (Name of schoo! and address) for the course effective Academic Year 2021-2022. In support to my application, attached are the following documents: ‘Senior High School Fourth (Final) Grading Report Card with General Weighted Average (GWA) of 85% or higher (Certified Photocopy by the Class Adviser) Regular Medical Certificate from a licensed physician (Original Copy) Social Case Study Report from the Municipality Social Welfare & Development Office(Original Copy) Certificate of Scholarship Eligibility’ Good Moral Character (PSP Form No. 2) Individual Information Sheet (PSP Form No. 3) with recent picture. (Taken within the last six (6) Months) | hereby authorize the Provincial Scholarship Program Management, Evaluation and Excellence Committe: (PSPMEEC) or its duly authorized representative, to investigate all facts concerning my skils, habits, character, background and suc! ‘other information pertinent to my qualifications. | understand that any misrepresentation, falsification or any omission of such fact, of whatever nature, required by this application shall be considered @ sufficient cause for denial of my application or termination of my scholarship privileges if alread granted. If accepted, | promise to abide by the rules and regulations, as embodied in the provisions of the Guidelines for PSP for ‘Academically Highly Competent College Students, which | have read and fully understood. ‘Cpplicant’s Signature over Printed Name) ‘Wane and Address of Schocl Graduated) CERTIFICATE OF SCHOLARSHIP ELIGIBILITY This isto certify that is @ candidate for graduation (Wame of applicant) from on (Name of school and address) ‘(Date of graduation) under the ‘and meets ail the requirements for graduation, (Academic Track Strand) This is to certify further that he'she is of good moral character. He/ She is a recipient of the following academic and non-academic awards and citations: ob ‘Award Received | Level tensed Title of Competition (Champion, Runner-Up | (Municipal, Provincial ec) | National te.) TOTAL NO. OF GRADUATING SENIOR HIGH SCHOOL STUDENTS: ATTESTED: (Gignature over Printed Name) Class Adviser of Applicant DatePSP Form No. 3 | INDIVIDUAL INFORMATION RECORD | Pleess paste uae | photo nere ‘mont Name: Age: Gender: Directions: Give what is being called for as accurately and honestly as you can. Any misrepresentation may disqualify you for the ‘Scholarship. PART Ill should be accomplished with the help of your parents or quardians. PARTI 4. Date of Birth (mmidd/year), Place of Birth, 2. Present Address 3. Contact Number 4. No. of years of stay in the present address, PARTI 1, Name and address of secondary schoo! 2. Classification of High Schoo! Curriculum, /__/General, ____/Vocations 3, Date of Graduation 4. Academic Honors Received 55. Non-Academic Honors Received 6 Special Talents and Skills PARTI 1. Father's Name Occupation Gross income per month ‘Amount of Income Tax paid for previous year 7__T Special Program (Pls. specify) 2. Mother's Name, ‘Occupation Gross Income per month ‘Amount of Income Tax paid for previous year 3. Guardian's Name (if applicable), Occupation Gross Income per month ‘Amount of income Tax paid for previous year 4. What do you like to be someday? ‘What does your father ike you tobe? ‘What does your mother like you to be? ‘What do your teachers like you to be? ‘What do your friends like you to be? ‘5. How many brothers and sisters do you have? How many are studying? Elementary Junior Figh Schoot ‘Senior High School College: ‘6. What other means of income does your family have aside from those mentioned in questions 1 and 2? Please lis them below: Other Sources of Income Monthly income 7. In at least 60 words, state your reason for applying for this colege scholarship, I HEREBY CERTIFY that the answers ATTESTED: to the foregoing are true and correct. ‘Hnplicante signature above printed name) (Parent s/Guardian’s signature above printed name) — ray @atey ee ‘Pave 3 af 3 (Anril 2071)