department of health office of the...
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Building 1, San Lazaro Compound, Rizal Avenue, Sta. Cruz, 1003 Manila ● Trunk Line 651-7800 local 1113, 1108, 1135 Direct Line: 711-9502; 711-9503Fax: 743-1829 ● URL: http://www.doh.gov.ph; e-mail: [email protected]
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jbp/cdmd/hhrdb/16-20
Republic of the Philippines
Department of Health
OFFICE OF THE SECRETARY
Ref. No.
Key Activities Responsibilities Reference
Document / Record
1 ▪ DOH announces the availability of the scholarship grant through the Regional Offices
▪ DOH-HHRDB ▪ DOH-ROs
▪ Department Memorandum
2 ▪ Students shall apply directly to the school and should meet the minimum requirements set by the partner institution Only those who have been admitted to the partner schools are eligible to apply for the DOH scholarship
▪ Partner schools ▪ List of potential scholars
3 ▪ Partner school shall submit the list of potential scholar to DOH for evaluation and approval of the DOH Scholarship Committee Successful scholars shall be notified through the Scholarships Department of the schools
▪ Department
Personnel Order shall be prepared for the Scholars
▪ DOH Scholarship committee
▪ DOH-HHRDB
▪ Department Personnel Order
Announcement of Scholarship
Grant offered
Application and
Screening
Evaluation and approval of successful
scholars
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Ref. No.
Key Activities Responsibilities Reference
Document / Record
4 ▪ Students shall be provided with the Scholarship Contract through the Regional Offices
▪ Partner schools shall sign a MOA with the DOH for the implementation of the grant
▪ DOH-HHRDB and ROs
▪ Scholarship contract for students
▪ Memorandum of Agreement with partner schools
5 ▪ Partner schools shall submit performance reports to the Regional Offices at the end of every school year semester with appropriate recommendations on the scholarship of the students
▪ Regional Offices shall provide updates to HHRDB on the status of the scholarships grant at the end of every school year semester with appropriate recommendations on the scholarship of the students and the performance of the partner schools
▪ Partner school ▪ DOH-RO
▪ Performance reports and recommended actions
6 ▪ Schools shall provide DOH the list of successful graduates and those who have failed to finish the course with complete contact details of the students
▪ Schools shall also provide DOH the list of student who opted to take the board exam and those who did not
▪ Partner school
▪ List of students that graduated
▪ List of board takers ▪ List of board
passers
Signing of Contracts and
MOA
Monitoring of Academic
Performance
Rendering of return service
obligations
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Ref. No.
Key Activities Responsibilities Reference
Document / Record
▪ Schools shall also provide the list of passers and those who have failed the exams
▪ Schools shall coordinate with the scholars to report to the respective Regional Office upon passing the board examination
▪ Students shall render (two) 2 years of service for every one (1) year of scholarship grant
▪ DOH-ROs
List of partner schools from Region I and II for
the DOH Pre Service Scholarship Program Medical Scholarship REGION I University of Northern Philippines REGION II Cagayan State University Midwifery Scholarship REGION I Union Christian College REGION I Urdaneta City University REGION I Eastern Pangasinan University
REGION I Don Mariano Marcos Memorial State
University REGION I North Luzon Philippines State College REGION II Isabela State University REGION II Quirino State University
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cev/cdmd/hhrdb/17-9
SELECTION CRITERIA FOR SCHOLARS
Name of Applicant: ___________________________________________ Date Evaluated: __________
Address: ____________________________________________________
SUMMARY
Category Weight Score
Category 1: Citizenship 5 SCORING:
1st Priority: more than 36
2ndPriority: 25– 35
Not a Priority: less than 25
Category 2: Health Condition 5
Category 3: School Admission 5
Category 4: Residence
4a: GIDA 10
4b: CADT Area/Indigenous Community 10
4c: Municipality Class/ City 5
4d: 20 Poorest Province 5
Category 5: Income (Monthly Gross) 10
Category 6: Affiliation 5
Total 60
CATEGORY 1: CITIZENSHIP
Criteria Weight Score
Filipino 5
Non- Filipino 0
Total
CATEGORY 2: HEALTH CONDITION
Criteria Weight Score
Physically and mentally fit 5
With illness 0
Total
CATEGORY 3: SCHOOL ADMISSION
Criteria Weight Score
Passed 5
Declined 0
Total
CATEGORY 4: RESIDENCE
Category 4a: Geographically Isolated and Disadvantaged Areas (GIDA)
Criteria Weight Score
GIDA 10
Non- GIDA 0
Total
Category 4b: Certificate of Ancestral Domain Title (CADT) Area/Indigenous Community
Criteria Weight Score
CADT Area/Indigenous Community 10
Non- CADT Area/ Non- Indigenous Area 0
Total
Category 4c: Municipality Class/ City
Criteria Weight Score
Sixth Class 5
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cev/cdmd/hhrdb/17-9
Criteria Weight Score
Fifth Class 4
Fourth Class 3
Third Class 2
Second Class 1
First Class 0
City 0
Total
Category 4d: 20 Poorest Province
Criteria Weight Score
Lanao del Sur (ARMM) 5
Maguindanao (ARMM) 5
Sulu (ARMM) 5
Mt. Province (CAR) 5
Agusan del Sur (Caraga) 5
Catanduanes (Region 5) 5
Sorsogon (Region 5) 5
Negros Oriental (Region 7) 5
Siquijor (Region 7) 5
Eastern Samar (Region 8) 5
Leyte (Region 8) 5
Northern Samar (Region 8) 5
Western Samar (Region 8) 5
Zamboanga del Norte (Region 9) 5
Zamboanga Sibugay (Region 9) 5
Bukidnon (Region 10) 5
Lanao del Norte (Region 10) 5
North Cotabato (Region 12) 5
Sarangani (Region 12) 5
Sultan Kudarat (Region 12) 5
Total
CATEGORY 5: INCOME (COMBINED MONTHLY GROSS FAMILY)
Criteria Weight Score
Php 30,000.00 per family member 0
Php 20,000.00 – 29,999.00 per family member 5
<Php19,999.00 per family member 10
Total
CATEGORY 6: AFFILIATION
Criteria Weight Score
Member of Minority Sector (e.g.Manobo, Aeta, Mangyan, Tausug, Maranao, Badjao, etc) 5
Dependent of Government Employee 5
Dependent of Barangay Health Worker 5
Dependent of Traditional Birth Attendant 5
Dependent of Police/ Soldier Fatally Wounded/ Killed on Duty 5
Victim of Calamities/ insurgencies 5
Total
Evaluated by: Noted by:
__________________________ ___________________________________
<NAME> <NAME>
Position/Designation Regional Director
Republic of the Philippines
Department of Health
DOH SCHOLARSHIP PROGRAM
APPLICATION FORM
Print legibly and use separate sheet if necessary. Place marks in appropriate boxes. Only accomplished application forms will be processed.
SCHOLARSHIP APPLIED FOR:
Medical Scholarship Program
Midwifery Scholarship Program
PERSONAL BACKGROUND [ ] Member of Ethnic Minority or Indigenous People
Specify:_____________________
[ ] Barangay Health Worker – Child
[ ] Traditional Birth Attendant - Child
[ ] Government Staff – Child
[ ] Victim of Calamity/ Insurgency
NAME:
(Surname)
(First Name)
(Middle Name)
DATE OF BIRTH:
PLACE OF BIRTH:
AGE: GENDER:
[ ]Female
[ ]Male
CIVIL STATUS:
[ ] Singe [ ] Widowed
[ ] Married [ ] Separated
NATIONALITY: Religious Affinity:
PERMANENT ADDRESS: Tel #:
MAILING ADDRESS:
Tel #:
CELLPHONE # (if any)
E-MAIL ADDRESS: (if any)
TIN #:
Philhealth # (if any)
LBP Account: (if any)
LBP Branch:
FAMILY BACKGROUND Father’s Name:
Age: Occupation: Salary:
Mother’s Name:
Age: Occupation: Salary:
Spouse’s Name:
Age: Occupation: Salary:
Number of siblings ______
Sibling Rank ______
Gross Monthly Family
Income:
Names of Children:
__________________________
__________________________
__________________________
Age(s)
__________
__________
__________
______
EDUCATIONAL BACKGROUND
LEVEL NAME OF SCHOOL
HIGHEST GRADE
FINISHED OR
DEGREE EARNED
INCLUSIVE
DATES OF
ATTENDANCE
SCHOLARSHIP/
HONOR(S) /
DISTINCTION
RECEIVED From To
ELEMENTARY
SECONDARY
VOCATIONAL /
TRADE COURSE
COLLEGE
GRADUATE
STUDIES
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Paste a recent 1” x 1” photograph (taken
within the last 6 months)
in this box.
EMPLOYMENT / SERVICE RECORD (Start from current work)
POSITION TITLE OFFICE/COMPANY INCLUSIVE
DATES
STATUS OF
EMPLOYMENT
MONTHLY
SALARY
REFERENCES
Please provide at least two (2) character references you are not related to.
NAME POSITION & ADDRESS CONTACT NO.
I declare that all information and documents submitted with this application form are true and correct pursuant to the
provisions of pertinent laws, rules and regulations of the Republic of the Philippines.
I authorize the agency head / authorized representative to verify / validate the contents stated herein. I trust that this
information shall remain confidential.
_____________________________
Applicant’s Signature over
Printed Name
__________________________
Date
Attachments:
1. Copy of Barangay Certification/ Certification of a Bona Fide Resident of the Community
2. Copy of Combined Family Income Tax Return (ITR)
3. Certificate of Indigency (if applicable)
4. Certification from National Commission on Indigenous Peoples (NCIP) (if applicable)
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