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BUKsu Application

The document is an application form for a graduate scholarship program at Bukidnon State University. It requests information such as the applicant's personal details, educational background, work experience, awards, and performance ratings. The applicant needs to attach supporting documents like transcripts, examination results, recommendation letters, medical certificates, and application fees. Division and regional education officers will review and approve the recommended applicants.

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andriesajarah
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191 views2 pages

BUKsu Application

The document is an application form for a graduate scholarship program at Bukidnon State University. It requests information such as the applicant's personal details, educational background, work experience, awards, and performance ratings. The applicant needs to attach supporting documents like transcripts, examination results, recommendation letters, medical certificates, and application fees. Division and regional education officers will review and approve the recommended applicants.

Uploaded by

andriesajarah
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOC, PDF, TXT or read online on Scribd
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BSU FORM saf-99

BUKIDNON STATE
UNIVERSITY Photo
Malaybalay City, Bukidnon, 8700 Tel (088) 221 2237;Telefax (088)813-2717
www.bsc.edu.ph

APPLICATION FORM

(For Graduate scholarship applicant)


Name:______________________________ Sex: _____ Civil Status _____ Ethnic Tribe: ____________
Date of Birth: _______________________ Age: _____ Place of Birth: __________________________
Complete Home Address: ______________________________________________________________
Office/School Address: ________________________________________________________________
Region: __________ Division: ________________________ Religion: __________________________

Program/major Field of Preference: (Check only one)


________ Master of Arts in Education major in Educational Administration
________ Master of Arts in Education major in English Language Teaching
________ Master of Arts in Education major in Mathematics Education (Secondary)
_________Master of Arts in Education major in Mathematics Teaching (Elementary)
________ Master of Arts in Science Education major in General Science

A. Educational Qualification:
Basic Educational Qualification

Degree Received College/University Major Field Year Taken


__________________ ___________________________ __________ _________
__________________ ___________________________ __________ _________
__________________ ___________________________ __________ _________

B. Civil Service/Board Examination(s) Passed:


Name of Examination Rating Date & Place of Exam
______________________ _______ __________________________________________
______________________ _______ __________________________________________
______________________ _______ __________________________________________

C. Educational Qualification:
Inclusive Dates Position Held Division/Office Total Yrs. Exp. Salary
______________ ____________ _________________ ____________ ____________
______________ ____________ _________________ ____________ ____________
______________ ____________ _________________ ____________ ____________

D. Honors/Awards Received or Earned (Give Description, Source & Date)


______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

E. Inservice Training Participation (In Administration, Supervision, English, Science/Biology and


Mathematics). Include only those on National and Regional levels.
Name of Inservice Place & Year Delegate/Observer Level
___________________ ___________________ ______________________ ___________
___________________ ___________________ ______________________ ___________
___________________ ___________________ ______________________ ___________

F. Scholarship, Fellowship of Travel previously enjoyed:


Nature of Field Sponsoring Agency/Place & Year Nature of Participation Level (Int’l, Reg’l. Local)
________________ _______________________ __________________ _______________
________________ _______________________ __________________ _______________
________________ _______________________ __________________ _______________
G. Outstanding Evidence of Educational Leadership (State position held or roles performed, where
and when, articles/books written)
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

H. Performance Rating: (For the last two years)


School Year Numerical Rating Adjective Rating
_________________ ___________________________ _______________________
_________________ ___________________________ _______________________
_________________ ___________________________ _______________________

THIS IS TO CERTIFY that the information given above is true and correct. The following
original/certified supporting papers are hereto attached: (put a check mark if the supporting paper
needed is attached).

_____ 1. Application Form (SAF-99)


_____ 2. BPS Form 127 (Record of service and allied experiences)
_____ 3. CS Form 212
_____ 4. Original Transcript of Records (Certified Xerox copy)
_____ 5. Weighted Average Computation Sheet(s) (Formula: multiply grade by credit and divide
sum of products by sum of credits, group by semester or summer term)
_____ 6. Performance Rating (Certified Xerox copy of at least two years)
_____ 7. CSE/Board Examination Report of Rating (Certified Xerox copy)
_____ 8. Schools Division Superintendent’s written recommendation as to innovative ability, drive for
achievement, and commitment to undertake a pilot project on any educational innovation.
_____ 9. General Form No. 86 (Accomplished by a government physician
_____ 10. Government Physician certification on Non-Pregnancy (for married female applicants only)
_____ 11. Very recent photo (2”x 2”) attached to each application form.
_____ 12. Special Order for Study Leave of Absent with full pay effective April 2019 to March 2020
_____ 13. Certification of Consent by the Spouse
_____ 14. Applicant’s certification on pending nomination for other form scholarship, fellowship,
training, etc. during the above-mentioned scholarship period.
_____ 15. A Non-Refundable Application/Examination Fee of P300 (cash), Psychological Test fee -
P475

RECOMMENDED: ________________________
(Signature of Applicant Over
Printed Name)

RAPHAEL C. FONTANILLA, Ph.D., CESO V


Schools Division Superintendent
APPROVED:

DR. ALLAN G. FARNAZO, CESO IV


Regional Director

(Note: All regional and division officers will be given a list of selected applicants.)

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