REPUBLIC OF THE PHILIPPINES

OFFICE OF THE PRESIDENT

COMMISSION ON HIGHER EDUCATION

SCHOLARSHIP FOR TRANSNATIONAL EDUCATION

APPLICATION FORM

RIVERA-LUTAP, JOCELYN A.
NAME OF APPLICANT
LAST NAME, GIVEN NAMES M.I.
Permanent Address
1363 F. Jhocson St. Sampaloc, Manila
(Philippines)
Contact No. Email
09189123497
jarlutap@pup.edu.ph
May
Female19, 1967Date of Birth . Sex
Civil Status Citizenship
Married
Filipino
Passport No. Date and Place
of Issue
Name and Address of
Polytechnic University of the Philippines
Sending HEI (Philippines)
HEI where applicant is currently employed or will render return service
Official Designation and
Dean,Teaching
College of Architecture and Fine Arts
Discipline
e.g., Instructor IV, Bioethics and Philosophy of Science
E: [number of enrollees]
Center of Excellence or No. of Enrollees
Center of Development Indicate if the department is and Faculty F: [number of faculty]
COE or COD
Degree Program to be ☐ Master’s Program Sought:
Pursued ☐Doctorate
Inclusive Dates of Study
mm/dd/yyyy to mm/dd/yyyy
Name and Address of
TNE DHEI
Email address of Contact no. of
TNE DHEI TNE DHEI

ATTACHMENTS
Staple this form to the front of your application. Incomplete applications will not be processed.
☐Curriculum Vitae (follow CHED template)
☐Certificate of acceptance/admission issued by TNE DHEI
☐Certified True Copies of Transcripts of Records of all higher education courses taken
☐Proof of citizenship (copy of PSA Birth Certificate, or information page of valid passport, or voter’s ID)
☐Statement of Purpose maximum of 750 words
☐Letter of Recommendation signed by the University President (follow CHED template)
☐Reentry Action Plan (follow CHED template)
☐ Notarized Return Service Agreement signed by the University President (follow CHED template)
☐Medical Certificate indicating fitness to undertake graduate studies, issued by a Philippine government physician
within the last six months.

DR./AR. JOCELYN A. RIVERA - LUTAP

Name and Signature of Applicant Date

Note: Application requirements should be submitted in electronic and physical copies.

PLEASE SUBMIT THE PHYSICAL COPY TO:

CHED INTERNATIONAL AFFAIRS STAFF

2F Higher Education Development Center
C.P. Garcia Ave., UP Diliman, Quezon City
 REPUBLIC OF THE PHILIPPINES
OFFICE OF THE PRESIDENT
COMMISSION ON HIGHER EDUCATION

SCHOLARSHIP FOR TRANSNATIONAL EDUCATION

Note: Application requirements should be submitted in electronic and physical copies.

PLEASE SUBMIT THE PHYSICAL COPY TO:

CHED INTERNATIONAL AFFAIRS STAFF

2F Higher Education Development Center
C.P. Garcia Ave., UP Diliman, Quezon City