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2025 CEAP Application FORM

The document is an application form for the College Educational Assistance Program (CEAP) in the Philippines, requiring personal and family information from applicants. It outlines eligibility criteria, documentary requirements, and consent for data processing under the Data Privacy Act. Applicants must certify the accuracy of their information and submit the completed form to the designated secretariat.

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39 views1 page

2025 CEAP Application FORM

The document is an application form for the College Educational Assistance Program (CEAP) in the Philippines, requiring personal and family information from applicants. It outlines eligibility criteria, documentary requirements, and consent for data processing under the Data Privacy Act. Applicants must certify the accuracy of their information and submit the completed form to the designated secretariat.

Uploaded by

lascotarioace
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Republic of the Philippines HOUSE OF REPRESENTATIVES

DISTRICT OFFICE OF CONGRESSWOMAN KRISTINE SINGSON


SAN NICOLAS, CANDON CITY, ILOCOS SUR

COLLEGE EDUCATIONAL ASSSISTANCE PROGRAM (CEAP) 2X2


ID PICTURE
APPLICATION FORM
Instructions: Read General and Documentary Requirements. Fill in all the required information. Do not leave an item blank.
If item is not applicable, indicate "N/A".

PERSONAL INFORMATION

1. Name
(Last Name) (First Name) (Middle Name) Maiden Name
put extension, if any: i.e. Jr., III (for Married
2. Date of Birth (mm/dd/yy) 9. Present Address

3. Place of Birth

4. Sex  Male
 Female 10. Zip Code

 Single
 Widowed 9. Permanent Address

5. Civil Status  Married


 Separated

 Annulled
 Others 10. Zip Code

6. Citizenship 11. Name of School Last Attended

7. Mobile Number 12. School Address

8. E-mail Address

13. School Sector: ( )Public ( )Private 15. Type of Disability (if applicable)

14. Highest Attained Grade/Year Level 16. IP affiliation (if applicable)

FAMILY COMPOSITION
Father: ( ) Living ( )Deceased Mother: ( ) Living ( ) Deceased Brother/Sister
17. Name

18. Date of Birth

19. Age

20. Occupation

21. Monthly Income

22. Contact Number

23. Highest Educational Attainment

24. Total Parents Taxable Income 24. No. of Siblings in the family including
stated above _________
25. Is your family a beneficiary of the DSWD's pantawid Pamilyang Pilipino Program (4Ps)? ( ) Yes ( ) No

26. School Intended to enroll or enrolled in:


27. School Address:
28. Type of School: ( ) Public ( ) Private
29. Degree Program:

30. Are you enjoying other sources of educational/financial assistance? ( ) Yes or ( ) No If yes, please specify 1.
_________________
I hereby certify that foregoing statements are true and correct. Any misinformation or witholding of information will automatically disqualify me from the CEAP Scholarship Program. I am willing to refund
the financial benefits received if such information is discovered after acceptance of the award.

I hereby express my consent for the Commission on Higher Education to collect, record, organize, update or modify, retrieve, consult, use, consolidate, block, erase or destruct my personal data as part
of my information. I hereby affirm my right to be informed, object to processing, access and rectify, suspend or withdraw my personal data and be indemnified in case of damages pursuant to the
provisions of the Republic Act No. 10173 of the Philippines, Data Privacy Act of 2012 and its corresponding Implementing Rules and Regulations.

(Signature over Printed Name of Applicant) Date Accomplished


Note: Fully accomplished form to be submitted to the SECRETARIAT
DO NOT FILL-OUT THIS PORTION (FOR CEAP COORDINATOR USE ONLY)
Belongs to: (any of the following groups) Documents Attached:
( ) dependent of solo parent senior citizens 1. Academic
( ) persons with disabilities, please specify type of disability ( ) Report Card ( ) Copy of Grades: Grade 11 or 1st semester of Grade 12
( ) indigenous and ethnic peoples, please specify membership 2. Financial
( ) ITR ( ) Tax Exemption ( ) Certifcate of Indigency ( ) Case Study DSWD ( )
please specify type of disability OFW Contract
please specify membership 3. Others
( ) Solo Parent ( ) Senior Citizen ( ) IPs ( ) PWD

Evaluated/Processed by:

CEAP Coordinator Date


CRITERIA OF ELIGIBILITY: DOCUMENTARY REQUIREMENTS:
1. Filipino citizen; Academic Requirements - any one of the
2. Graduating high school students/High ( ) 1. Senior High school report card or
3. General Weighted Average (GWA) of at least ( ) 2. Certificate of Final Grades of Last Semester Attended
4. Combined annual gross income of parents/guardian not to exceed Documentary Requirements:
In highly exceptional cases where income exceeds Php400,000.00, ( ) 1. Birth Certificate
the CHEDRO StuFAPs Committee shall determine the merits of ( ) 2. Certificate of Good Moral from last school attended
5 Avail of only one government funded financial assistance ( ) 3. Certificate of Indigency and Residency from their Barangay
( ) 4. Endorsement from Municipal Mayor
Note: Beneficiaries of free higher education under RA 10931 can ( ) 5. Application letter addressed to the program sponsor.
only

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