Submission of Application for MGB Undergraduate Local Scholarship for Baccalaureate Degrees in Geology, Mining Engineering and Metallurgical Engineering Starting SY 2012-2013 This is to announce that the Mines and Geosciences Bureau (MGB) will have at least eight (8) available slots for undergraduate local scholarship program and is now accepting applications for Baccalaureate Degrees in Geology, Mining Engineering and Metallurgical Engineering for school year 2012-2013. Applicants for the scholarship program may be high school graduates; students currently enrolled in college/university or qualified personnel currently employed with the MGB. To qualify, applicant must possess the following qualifications and should submit the following documents to the Director of MGB: For MGB Employees A permanent employee at the time of filing. (Interested qualified non-permanent employee can apply but will have to resign) Has rendered at least two (2) uninterrupted years of service in the MGB Not more than 35 years old at the time of application Has high scholastic ratings in high school or in college, if with earned units of BS Geology, Mining Eng g and Metallurgical Eng g If currently enrolled, must be enrolled in school /university/college offering the courses of BS Geology, Mining Eng g and Metallurgical Eng g and has been granted permission to shift either to BS Geology, Mining Eng g or Metallurgical Eng g course Scholarship Committee. Personnel from the MGB Regional Offices should be duly endorsed by the Regional Director concerned. Personal Data Sheet Service Record Transcript of scholastic records Certificate of Admission (CA) from the school/university/college where he/she intends to enroll. In case the CA is not yet available, a certified copy of the application for Admission shall be temporarily accepted Certificate that he/she is currently enrolled in the school/university/college and has been granted permission to shift either to BS Geology, Mining Eng g or Metallurgical Eng g course as certified by the school Dean or Department Head No pending administrative and/or criminal case Certificate of good moral character from immediate supervisor Certification of no pending administrative or criminal case Certification from immediate supervisor that the study leave will not hamper the operations of the unit Has obtained performance ratings of Very Satisfactory for the last two (2) consecutive rating periods prior to the filing of application Must not have availed of any foreign or local scholarship in the past 2 years prior to filing of application Copy of performance evaluation (PES) for the last two (2) consecutive rating periods duly confirmed by the Performance Evaluation Review Committee (PERC) of his/her Office Certificate that he/she has not availed of any foreign or local scholarship in the past two (2) years For High School Graduate Scholarship Committee. MGB Information Sheet F:\MGB\For Posting\ANNOUNCEMENT on MGB UNDERGRADUATE LOCAL SCHOLARSHIP 2012-2013.doc 1
Graduated in high school in the upper ten (10) percentile with preference to valedictorian or salutatorian of BS Geology, Mining Engineering and A copy of Income Tax Return (ITR) for CY 2011 of parents or guardians Form 138 Certificate of Admission (CA) from school/university/college where he/she intends to enroll. In case the CA is not yet available, a certified copy of the application for Admission shall be temporarily accepted. Metallurgical Engineering With good moral character Certificate of good moral character as certified by the principal For Currently Enrolled Students Must have obtained a weighted average of 2.5 or its equivalent in academic subjects completed of BS Geology, Mining Eng g and Metallurgical Eng g Or must be enrolled in school /university/college offering the courses of BS Geology, Mining Eng g and Metallurgical Eng g and has been granted permission to shift either to BS Geology, Mining Eng g or Metallurgical Eng g course Police or NBI Clearance Scholarship Committee. MGB Information Sheet A copy of ITR for CY 2011 of parents or guardians Transcript of scholastic records Certificate of Admission (CA) from the school/university/college where he/she intends to enroll. In case the CA is not yet available, a certified copy of the application for Admission shall be temporarily accepted. Certificate that he/she is currently enrolled in the school/university/college and has been granted permission to shift either to BS Geology, Mining Eng g or Metallurgical Eng g course as certified by the school Dean or Department Head With good moral character Certificate of good moral character as certified by the school Dean or Department Head Police or NBI Clearance Please submit all applications and supporting documents to: THE DIRECTOR Mines and Geosciences Bureau North Avenue, Diliman, Quezon City Attention: MGB Personnel Development Committee c/o Administrative Division Mines and Geosciences Bureau-Central Office Deadline for submission of application is on April 15, 2012. Incomplete documents and late submission will not be processed. F:\MGB\For Posting\ANNOUNCEMENT on MGB UNDERGRADUATE LOCAL SCHOLARSHIP 2012-2013.doc 2
Name of School: Address: _ PRINCIPAL S CERTIFICATION Date: This is to certify that is a candidate for graduation for the school year and belongs to the top % of the total (number) graduating students. Signature of Principal ---------------------------------------------------------------------------------------------------------------- Name of School: Address: _ CERTIFICATE OF MORAL CHARACTER Date: This is to certify that has NO DEROGATORY RECORDS extant in this Office while studying in this school, for he/she is known to be a person of unquestionable moral character. NOTE: Failure to maintain good moral character before the award of the scholarship shall cause forfeiture thereof. MGB may require another certification before the signing of the scholarship agreement. Signature of Principal/Guidance Councilor F:\MGB\For Posting\ANNOUNCEMENT on MGB UNDERGRADUATE LOCAL SCHOLARSHIP 2012-2013.doc 3
Health Agency: Address: HEALTH CERTIFICATE Date: This is to certify that I have examined and found him/her to be physically and mentally fit. This certification is issued in connection with his/her application for the 2009-2010 MGB Undergraduate Local Scholarship Program. Signature of Medical Officer License No. ---------------------------------------------------------------------------------------------------------------- PARENTS/GUARDIANS CERTIFICATION This is to certify that the undersigned has no pending application for immigration for the USA or any other country. Signature of Parent I certify that all answers given above are true and correct to the best of my knowledge. I will also abide with the policy of the program that the selection of qualified applicants for scholarship award after recommendation by the MGB-Local Scholarship Committee is final and appealable. Attested by: Parent/Guardian Signature over Printed Name Parent/Guardian Signature over Printed Name Date: F:\MGB\For Posting\ANNOUNCEMENT on MGB UNDERGRADUATE LOCAL SCHOLARSHIP 2012-2013.doc 4
Application No. Republic of the Philippines Department of Environment and Natural Resources MINES AND GEOSCIENCES BUREAU North Avenue, Diliman, Quezon City Passport size photo INFORMATION SHEET for the 2012-2013 MINES AND GEOSCIENCES BUREAU UNDERGRADUATE SCHOLARSHIP PROGRAM (Note: Please PRINT all information asked) A. PERSONAL DATA 1. Name: Last First Middle Name 2. Sex: 3. Contact No.: 4. Date of Birth: 5. Place of Birth: 6. Permanent Home Address: 7. Municipality/District: 8. Zip Code: 9. Name of Last School Attended: 10. Address of Last School Attended: B. FAMILY DATA (If parents are deceased, give data of the guardian or nearest relative and indicate relationship to you.) FATHER 11. Name: 12. Name: MOTHER 13. Citizenship: 14. Citizenship: 15. Highest Educational Attainment: 16. Highest Educational Attainment: 17. Occupation (please specify) 18. Occupation (please specify) 19. Employer/Business Name: 20. Employer/Business Name: 21. Address of Employer 22. Address of Employer: 23. Gross Income for CY 2008: 24. Gross Income for CY 2008: 25. Number of Children in the family: 26. Family Ordinal (1 st /2 nd /3 rd /etc): (Signature over Printed Name) F:\MGB\For Posting\ANNOUNCEMENT on MGB UNDERGRADUATE LOCAL SCHOLARSHIP 2012-2013.doc 5