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Certification: Change in Study Plan

This document is a certification form for graduate school scholarships through local programs. It requires information about the scholar such as name, student ID, and degree program. It also needs the school year, term, subjects for certification, and type of certification being requested, whether it be a change in study plan or months covered in the term. The scholar and institutional representative both need to sign to certify the information provided is true and that the scholar is eligible to continue their studies.

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Steffi
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27 views

Certification: Change in Study Plan

This document is a certification form for graduate school scholarships through local programs. It requires information about the scholar such as name, student ID, and degree program. It also needs the school year, term, subjects for certification, and type of certification being requested, whether it be a change in study plan or months covered in the term. The scholar and institutional representative both need to sign to certify the information provided is true and that the scholar is eligible to continue their studies.

Uploaded by

Steffi
Copyright
© © All Rights Reserved
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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CERTIFICATION

SCHOLARSHIPS FOR GRADUATE SCHOOLS - LOCAL

SCHOLAR NAME: __________________________________ UNID: ______________________

SHEI NAME: ____________________________________________________________________

DHEI NAME: ____________________________________________________________________

PROGRAM: ____________________________________________________________________

School Year _________________________

Term: □ 1st Term □ 2nd Term □ 3rd Term □ 4th Term

□ Non-Regular Term (please specify): __________________________________

Subjects for ______________________________ _________________________________

Certification: ______________________________ _________________________________

Certification □ Change in Study Plan □ Months covered in the term


requested:

Change in Study Plan

The number of units taken for this term is less than what is stated in the study plan. This is due to:

□ Unavailability of subjects for the term


□ Others (please specify): ________________________________________________________

_______________________________________________________________________________

In connection with this, this is to further certify that this will not create any changes in the estimated
time of completion for my degree program due to the following reasons: _______________________

___________________________________________________________________________________.

(Attach original and modified study plan).


Months Covered in the Term

This is to certify that the scholar has been attending his/her classes for the term stated above for the
following duration:

Start Month: ______________ End Month: ______________

To be accomplished by the scholar: To be accomplished by the DHEI Representative:

I certify that the information indicated are valid, This is to certified that the above information is correct
authentic, true and correct based on my own personal and the scholar is eligible to enroll in the next
knowledge and based on documents in my possession. semester, consistent with the policies of the
I further certify that my actions are in line with the institution.
terms and conditions of my scholarship grant.

_____________________________________________
____________________________________________
Name and Signature of Scholar and Date Signed
Name and Signature of The Authorized
Representative and Date Signed

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