CMO No.

03, series of 2016

Appendix 2: SHEI Nomination Form

Office of the President of the Philippines

COMMISSION ON HIGHER EDUCATION

HEDC Bldg. C.P. Garcia Avenue, UP Campus, Diliman, Quezon City

K to 12 Transition Program Management Unit

SHEI NOMINATIONS FOR THE K TO 12 TRANSITION PROGRAM SCHOLARSHIPS

Instructions: Encode all answers in this form and submit accomplished proposal to
ched.scholarships@gmail.com with this subject: SHEI Nominations Name of School (e.g.
SHEI Nominations University of the Philippines). The actual digital form to be used can be
downloaded at https://chedk12.wordpress.com/scholarships-for-graduate-studies-andprofessional-advancement/. It is advised to use the latest versions of Microsoft Word (MS
2010 onwards) as some features of this file may not function using the earlier versions.
I. SHEI Information
SHEI Name
Enter complete name here
Campus
<Select one>

Page 1 of 7

II. List of Nominated Faculty (Add rows as necessary)

III.
IV.

VI.

V.
Teaching Discipline
Scholarship being applied for
VII. Program Title
VIII. Delivering HEI
IX.
(If known/prospective)
X.
Employment Status
XI.

XIII.
XIV.

Name of Faculty

(Last Name, First Name, Middle Initial)

XII.

(Full/Part Time)

Tenure

(Permanent/ Nonpermanent)

Last Name, First Name, Middle Initial

XV.

Enter teaching discipline here

XVI.
<Select one>

XVII. Name and Signature of HEI President

XVIII.
XIX. Date Submitted: MM/DD/YYYY
XX.

Page 2 of 7

XXI.
Individual Justification (This section is to be accomplished for EACH nominated
faculty. Please reproduce as necessary.)
XXII.
XXIII. A. Faculty Profile (Please provide complete information on the faculty.)
XXIV. Name of Faculty
XXV. First Name, Middle Initial, Last Name
XXVI. Age
XXVII.
Enter age here
XXVIII.
Highest Degree Attained
XXIX. (e.g. Master in Development Economics)
XXX. Date Graduated
XXXI. MM/DD/YYYY
XXXII.
Teaching Discipline
XXXIII.
Enter teaching discipline here
XXXIV.
Scholarship being applied for
XXXV.
<Select one>

XXXVI.
XXXVII.
XXXVIII.
XXXIX.

DHEI where degree will be obtained/completed

Enter complete name of DHEI here
Employment Status

<Select one>

XL.
XLI.
1.
2.
3.

B. Justification (Concisely justify your nomination of the faculty.)

Guide Questions:
How long has the applicant been with your department?
How has the applicant performed as a faculty member in your department?
How will the nominees study/career plans contribute to (1) importance and value
to SHEI, (2) importance and value to regional and national development, and (3)
importance and value to the discipline or profession?

XLII. Enter text here

XLIII.

XLIV.
XLV. C. Requirements Submission (Kindly tick the box of the requirement already
submitted along with this form.)
XLVI.
XLVII. Curriculum Vitae (accomplish attached CV template)

XLVIII.
XLIX. Transcript of Records (certified true copy)

L. LI.
Thesis/Dissertation Proposal (One-pager; for those with Ongoing Graduate

Studies)
LII. LIII. Proof of Citizenship (NSO authenticated birth certificate, information page of

valid passport, or voters ID)

LIV. LV.
Medical Certificate (issued by a government physician within the last six

months)
LVI. LVII. Re-entry Plan and Return Service Contract between SHEI and Faculty

LVIII.
LIX. Completed Templates 5 and 6 of the Strategic Faculty and Staff Development

Planning Workshop
LX.
LXI.

LXII.
LXIII.
LXIV.
LXV. First Name, Middle Initial, Last Name
LXVI. Name and Signature of Person who
accomplished this section
LXVII.
LXVIII.
Date Submitted: MM/DD/YYYY
LXIX.
LXX.

LXXI. List of Nominated Non-Teaching Staff (Add rows as necessary)

LXXII.
LXXIII.
Name of Non-Teaching Staff
LXXIV. (Last Name, First Name, Middle Initial)

LXXV.Designation & Department

LXXVI.
Scholarship being applied for
LXXVII.
Program Title
LXXVIII.
Delivering HEI
LXXIX.
(If known/prospective)
LXXX.
Employment Status
LXXXI. (Full/Part Time)

LXXXII.
Tenure
LXXXIII.
(Permanent/ Nonpermanent)
LXXXIV.

Last Name, First Name, Middle Initial

LXXXVI.
LXXXVII.
LXXXVIII.
LXXXIX.
XC.
XCI.
XCII.
XCIII.
XCIV.
XCV.
XCVI.
XCVII.
XCVIII.
XCIX.
C.
CI.
CII.

LXXXV.
I certify that the information provided herein, and in the enclosed documents, is true and correct.

I.

(e.g. Research Staff I / Department of Economics)

II.
<Select one>

III.
V.

Name and Signature of HEI President

IV.
Date Submitted: MM/DD/YYYY

CIII.
Individual Justification (This section is to be accomplished for EACH nominated
non-teaching staf. Please reproduce as necessary.)
CIV.
CV.
A. Personnel Profile (Please provide complete information.)
CVI. Name of Non-Teaching Staff
CVII. First Name, Middle Initial, Last Name
CVIII. Age
CIX. Enter age here
CX. Highest Degree Attained
CXI. (e.g. Bachelor of Arts in Economics)
CXII. Date Graduated
CXIII. MM/DD/YYYY
CXIV. Designation
CXV. (e.g. Research Staff I)
CXVI. Department
CXVII.
(e.g. Department of Economics)
CXVIII.
Scholarship being applied for
CXIX.
<Select one>

CXX. DHEI where degree will be obtained/completed

CXXI. Enter complete name of DHEI here
CXXII.
Employment Status
CXXIII.
<Select one>

CXXIV.B. Justification (Concisely justify your nomination of the faculty.)

CXXV.
Guide Questions:
4. How long has the applicant been with your department?
5. How has the applicant performed as a non-teaching staff in your department?
6. How will the nominees study/career plans contribute to (1) importance and value
to SHEI, (2) importance and value to regional and national development, and (3)
importance and value to the discipline or profession?

CXXVI.

Enter text here

CXXVII.

CXXVIII.
CXXIX.
C. Requirements Submission (Kindly tick the box of the requirement
already submitted along with this form.)
CXXX.
CXXXI.
Curriculum Vitae (accomplish attached CV template)

CXXXII.
CXXXIII.
Transcript of Records (certified true copy)

CXXXIV.
CXXXV.
Thesis/Dissertation Proposal (One-pager; for those with Ongoing

Graduate Studies)
CXXXVI.
CXXXVII.
Proof of Citizenship (NSO authenticated birth certificate, information page

of valid passport, or voters ID)

CXXXVIII.
CXXXIX.
Medical Certificate (issued by a government physician within the last six

months)
CXL.CXLI. Re-entry Plan and Return Service Contract between SHEI and Faculty

CXLII.
CXLIII.
Completed Templates 5 and 6 of the Strategic Faculty and Staff

Development Planning Workshop

CXLIV.
CXLV.

CXLVI.
CXLVII.
CXLVIII.
CXLIX.

First Name, Middle Initial, Last

Name
CL.
Name and Signature of Person who
accomplished this section
CLI.
CLII. Date Submitted: MM/DD/YYYY

CLIII.