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    MSRS Evaluation Form

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    tina
    This document provides an evaluation sheet for medical scholarship applicants seeking to participate in a return service program. It outlines 6 categories used to score applicants, including assessments of an applicant's residency location, family income, affiliations, entrance exam scores, and academic performance. Applicants must receive a score of 50 or higher to be considered qualified for the program. The evaluator provides scoring for each category and recommendations. The dean then notes the evaluation.

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    MSRS Evaluation Form

    Uploaded by

    tina
    4 views4 pages
    This document provides an evaluation sheet for medical scholarship applicants seeking to participate in a return service program. It outlines 6 categories used to score applicants, including assessments of an applicant's residency location, family income, affiliations, entrance exam scores, and academic performance. Applicants must receive a score of 50 or higher to be considered qualified for the program. The evaluator provides scoring for each category and recommendations. The dean then notes the evaluation.

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    MSRS_Evaluation_Form

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    This document provides an evaluation sheet for medical scholarship applicants seeking to participate in a return service program. It outlines 6 categories used to score applicants, including assessments of an applicant's residency location, family income, affiliations, entrance exam scores, and academic performance. Applicants must receive a score of 50 or higher to be considered qualified for the program. The evaluator provides scoring for each category and recommendations. The dean then notes the evaluation.

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    Download as DOCX, PDF, TXT or read online from Scribd
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    Download as docx, pdf, or txt
    4 views4 pages

    MSRS Evaluation Form

    Uploaded by

    tina
    This document provides an evaluation sheet for medical scholarship applicants seeking to participate in a return service program. It outlines 6 categories used to score applicants, including assessments of an applicant's residency location, family income, affiliations, entrance exam scores, and academic performance. Applicants must receive a score of 50 or higher to be considered qualified for the program. The evaluator provides scoring for each category and recommendations. The dean then notes the evaluation.

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    of 4

    MEDICAL SCHOLARSHIP AND RETURN SERVICE PROGRAM EVALUATION

    SHEET
    Date Evaluated:__________________

    Name of Applicant:
    Address: _______________________________________________________________
    Name of HEI: College of Medicine, University of the Philippines Manila
    Course and Year Level:___________

    SUMMARY

    SCORING:
    Qualified: 50 and above Not Qualified:
    below 50

    Category Weight Score

    Category 1: Assessment 10

    Category 2: Residency

    2a: Geographically Islated and Disadvantaged Areas 20

    (GIDA), calamity-prone and conflict areas

    2b: Certificate of Ancestral of Domain Title (CADT) Area / 10

    Indigenous Community

    2c: Municipality Class/City 10

    Category 3: Income (Annual Gross Income) 5

    Category 4: Affiliation 5

    Category 5: National Medical Admission Test (NMAT) 20

    Category 6: General Weighted Average (GWA) 20

    Total 100

    CATEGORY 1: ASSESSMENT

    Criteria Weight Score

    Interview / Exam 10

    No Interview / Exam 0

    Total

    CATEGORY 2: ASSESSMENT
    Category 2a: Geographically Isolated and Disadvantaged Areas (GIDA)

    Criteria Weight Score

    GIDA Barangay 20

    Municipality with GIDA Barangay 10

    Non-GIDA 0

    Total

    Barangay and Municipality:

    Category 2b: Certificate of Ancestral Domain Title (CADT) Area / Indigenous Community

    Criteria Weight Score

    CADT Area/Indigenous Community 10

    Non-CADT Area/Non-Indigenous Community 0

    Total

    CADT Area/Indigenous Community:

    Category 2c: Municipality Class/City

    Criteria Weight Score

    Sixth (6th) Class 5

    Fifth (5th) Class 4

    Fourth (4th) Class 3

    Third (3rd) Class 2

    Second (2nd) Class 1

    First (1st) Class 0

    City 0

    Total

    Municipality/City (please attach accompanying proof):

    CATEGORY 3: INCOME (COMBINED ANNUAL GROSS FAMILY INCOME)

    Criteria Weight Score

    >Php800,001.00 0

    Php450,001.00-800,000.00 1

    Php350,001.00-450,000.00 2
    Php300,001.00-350,000.00 3

    Php250,001.00-300,000.00 4

    <Php250,000.00 5

    Total

    (please attach accompanying proof)

    CATEGORY 4: AFFILIATION

    Criteria Weight Score

    Member of Indigenous People or Minority Group (e.g. Manobo, 5


    Aeta, Mangyan, Tausug, Maranao, Badjao, etc)

    Dependent of Community Health Volunteer 5

    Victim of Calamities/Insurgencies 5

    Whose Parents are suffering from Chronic Disease(e.g 5


    Undergoing Dialysis, CA patients / PWD / Solo Parent)

    Total

    Details of Affiliation:

    CATEGORY 5: NATIONAL MEDICAL ADMISSION TEST (NMAT)

    Criteria Weight Score

    NMAT Score 100

    Divided by 100 100

    Multiplied by 10 20

    Total

    NMAT Score (please attach accompanying proof):

    CATEGORY 6: GENERAL WEIGHTED AVERAGE (GWA)

    Criteria Weight Score

    GWA Score 100

    Divided by 100 100

    Multiplied by 10 20

    Total
    GWA (please attach accompanying proof):

    RECOMMENDATIONS:

    ______________________________________________________________________
    ______________________________________________________________________
    ______________________________________________________________________
    ______________________________________________________________________
    ____________

    Evaluated by: Noted by:

    MA. LIZA ANTOINETTE M. GONZALES, MD, MSc CHARLOTTE M. CHIONG, MD, PhD

    Associate Dean for Faculty & Students Dean

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