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    SGS-L Special Request Forms - LOA Request

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    annie
    This document contains a request for leave of absence from graduate studies under the CHED Scholarships for Graduate Studies - Local. It requires approval signatures from the scholar's Department of Higher Education Institution (DHEI) and Scholarships and Educational Institution (SHEI). If approved, the scholar's scholarship privileges and service obligation period will be adjusted accordingly for the duration of the leave.

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    © All Rights Reserved
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    SGS-L Special Request Forms - LOA Request

    Uploaded by

    annie
    53 views3 pages
    This document contains a request for leave of absence from graduate studies under the CHED Scholarships for Graduate Studies - Local. It requires approval signatures from the scholar's Department of Higher Education Institution (DHEI) and Scholarships and Educational Institution (SHEI). If approved, the scholar's scholarship privileges and service obligation period will be adjusted accordingly for the duration of the leave.

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    © © All Rights Reserved

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    This document contains a request for leave of absence from graduate studies under the CHED Scholarships for Graduate Studies - Local. It requires approval signatures from the scholar's Department of Higher Education Institution (DHEI) and Scholarships and Educational Institution (SHEI). If approved, the scholar's scholarship privileges and service obligation period will be adjusted accordingly for the duration of the leave.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    53 views3 pages

    SGS-L Special Request Forms - LOA Request

    Uploaded by

    annie
    This document contains a request for leave of absence from graduate studies under the CHED Scholarships for Graduate Studies - Local. It requires approval signatures from the scholar's Department of Higher Education Institution (DHEI) and Scholarships and Educational Institution (SHEI). If approved, the scholar's scholarship privileges and service obligation period will be adjusted accordingly for the duration of the leave.

    Copyright:

    © All Rights Reserved
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    SCHOLARSHIPS FOR GRADUATE STUDIES - LOCAL 
    REQUEST FOR LEAVE OF ABSENCE 
     
    SCHOLAR NAME: _______________________________ UNID:  __________________________ 
    SHEI NAME:  _____________________________________________________________________ 
    DHEI NAME:  _____________________________________________________________________ 
    PROGRAM: _____________________________________________________________________ 
     
    “As  stipulated  in  CHED  Memorandum Order (CMO) No. 4, s. 2017, Article VI (Terms 
    and  Conditions),  the  scholar shall submit a formal request for Leave of Absence to 
    the  Commission.  The  scholar  shall  detail  the  reasons  for  and  other  pertinent 
    details  regarding  the  request,  attaching  the  endorsement  from  his/her  SHEI,  and 
    written approval from his/her DHEI.  
     
    Furthermore,  scholars  who  have  been  approved  for  leave  for  the  terms indicated 
    shall  not  receive the scholarship privileges of the said terms. The scholarship shall 
    be  deemed terminated should the scholar not re-enroll after one (1) academic year 
    or after two (2) semesters and one (1) summer.” 
     
     
     
    Name of DHEI : ________________________________________________________________ 
    Degree Program : ______________________________________________________________ 
    Admitted : AY _______________ Term _____________ 
     
     
    I  would  like  to  request  for  a  Leave  of  Absence  starting  AY  __________,  Term  ___________  to  AY 
    __________,  Term  ___________.  This  covers  _____  regular academic term/s, and _____ special or 
    non-regular  term,  and  is  equivalent  to  _____  months.  The  leave  is  due  to: 
    ______________________________________________________________________________
    ______________________________________________________________________________
    ______________________________________________________________________________
    ______________________________________________________________________________
    ______________________________________________________________________________. 
     
    (Attach separate sheet if necessary)  
     
     
     
     
     
    ________________________________________ 
    Name and Signature of the Scholar and Date Signed 
     
     
     
     
     
     
     
     
     
     

     
     
    <<LETTERHEAD OF DHEI>> 
     
     
    J. PROSPERO E. DE VERA III, DPA 
    Chairman 
    Commission on Higher Education 
    4/F, HEDC Building, C.P. Garcia Avenue 
    Diliman, Quezon City, 1101 
     
    Thru : NELSON G. CAINGHOG 
    Director-in-Charge 
    Scholarships for Graduate Studies - Local 
     
    This  is  to  inform  your  office  that  the  request  of  __________________________,  a  student  of 
    (Degree  Program)  _________________________  under  the  CHED  Scholarships  for  Graduate 
    Studies Local to request for a leave of absence has been:  
    ⭘ Approved  
    ⭘ Disapproved  
     
    The  leave  of  absence  will  start  on  AY  __________,  Term  ________  to  AY  __________,  Term 
    ___________.  This  covers  _____  regular  academic  term/s,  and  _____  special  or  non-regular  term, 
    and  is  equivalent  to  _____  months.  The  leave  is  due  to: 
    ______________________________________________________________________________ 
    ______________________________________________________________________________
    ______________________________________________________________________________. 
     
     
     
    For your consideration. 
     
    Noted by:  
     
    Name of Grants Management Officer:  ______________________________________ 

    Signature:   ______________________________________ 

    Date:   ______________________________________ 
     
     
    Name of Dean of College:  ______________________________________ 

    Signature:   ______________________________________ 

    Date:   ______________________________________ 
     
     
     
     

     
    <<LETTERHEAD OF SHEI>> 
     
     
    J. PROSPERO E. DE VERA III, DPA 
    Chairman 
    Commission on Higher Education 
    4/F, HEDC Building, C.P. Garcia Avenue 
    Diliman, Quezon City, 1101 
     
    Thru : NELSON G. CAINGHOG 
    Director-in-Charge 
    Scholarships for Graduate Studies - Local 
     
    This  is  to  inform  your  office  that  the  request  of  ______________________________,  a  student  of 
    (Degree  Program)  ____________________________________________  under  the  CHED 
    Scholarships for Graduate Studies Local to request for a leave of absence has been:  
    ⭘ Approved  
    ⭘ Disapproved  
     
    The  leave  of  absence  will  start  on AY ________, Term _______ to AY _________, Term _________. 
    This  covers  _____ regular academic term/s, and _____ special or non-regular term, and is equivalent 
    to  _____  months.  The  leave  is  due  to:  __________________________________________ 
    ______________________________________________________________________________
    ______________________________________________________________________________. 
     
    This  is  to  further  certify  that  the  service  obligation  of  the  scholar  shall  likewise  be  adjusted  in 
    proportion  to  the  extended  period  as  stated  above  and  in  accordance  with  the  scholar’s  agreement 
    with (SHEI) _________________________________. 
     
     
    For your consideration. 
     
     
    Noted by:  
     
    Name of SHEI Coordinator:  ______________________________________ 

    Signature:   ______________________________________ 

    Date:   ______________________________________ 
     
    Name of Head of Institution or Authorized   
    Representative:  ______________________________________ 

    Position:  ______________________________________ 

    Signature:   ______________________________________ 

    Date:   ______________________________________ 

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