SCHOLARSHIPS FOR GRADUATE STUDIES - LOCAL 

 
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.  
 
LEAVE OF ABSENCE 
 
Name of DHEI: _______________________________________________________________ 
Degree Program : ____________________________________________________________ 
Admitted : AY _______________ Term _____________ 
 
 
I would like to request for a Leave of Absence from the scholarship1 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 
 
 
 

1
Requesting a Leave of Absence from the scholarship does not automatically indicate a request for Leave of
Absence from the Delivering Higher Education Institution (DHEI), the arrangements of which will depend on the
institutional policies of the institution.
J. PROSPERO E. DE VERA III, DPA 
Chairman 
Office of the Chairman 
Commission on Higher Education 
4/F, HEDC Building, C.P. Garcia Avenue 
Diliman, Quezon City, 11011 
 
Thru : ATTY. CINDERELLA FILIPINA BENITEZ-JARO 
Officer-in-Charge, Office of the Executive Director 
Director IV, Legal and Legislative Service 
 
 
This  is  to  inform  your  office  that  the  endorsement  of  the  request  of  leave  of  absence  of 
__________________________,  a  student  of  (Degree  Program) 
_________________________ under the CHED Scholarships for Graduate Studies - Local is:  
​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:   ______________________________________ 
 
 
 
 
 
J. PROSPERO E. DE VERA III, DPA 
Chairman 
Office of the Chairman 
Commission on Higher Education 
4/F, HEDC Building, C.P. Garcia Avenue 
Diliman, Quezon City, 1101 
 
Thru : ATTY. CINDERELLA FILIPINA BENITEZ-JARO 
Officer-in-Charge, Office of the Executive Director 
Director IV, Legal and Legislative Service 
 
 
This  is  to  inform  your  office  that  the  endorsement  of  the  request  for  leave  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 and Position of Authorized   
Representative:  ______________________________________ 

Signature:   ______________________________________ 

Date:   ______________________________________