Part 1. Eligibility Check: "One Professional Per Family"

ACCESS TO HIGHER AND MODERN EDUCATION (AHME)
Application Serial Number:
Instructions: READ THE ITEMS AND THE DOCUMENTARY REQUIREMENTS CAREFULLY. 2x2
FILL IN ALL THE REQUIRED INFORMATION and WRITE LEGIBLY. ALL FIELDS with ASTERISK ( * ) ID Picture
are REQUIRED. Do not leave an item blank. If item is not applicable, indicate "N/A".
PART 1. ELIGIBILITY CHECK

1. Are you a Bangsamoro*?
YES NO
2. Are you a Senior high school (SHS) or Alternative Learning System (ALS) graduate*?
YES NO
3. Are you enrolled or enrolling in a BARMM Regional Priority Program*?

YES NO
If yes, please select your preferred program/course: _ _
Refer to the BARMM Regional Priority Programs for AY 2020-21 at page 4
4. Do you belong to an underprivileged, disadvantaged, marginalized, poor or low-

income sector or group*? (please select at least one field that apply)
Combined gross annual income of parents or guardian does not exceed Php
400,000.00
An orphan
A child of a solo parent
A person with disability (PWD) or a child of a PWD
A member of Indigenous People (IP) or child of an IP Parent
Guardian is a senior citizen
An internally displaced person (IDP)
5. Are you a recipient of any scholarship, grant, or program that offers financial benefits*?
YES NO
PART 2. PERSONAL INFORMATION

First Name*: _ Date of Birth* _________________ __
Middle Name: _ _ Place of Birth*: _
Last Name*: _ _ Ethnic Affiliation*: _
Gender*: MALE FEMALE Citizenship*: __
Civil Status*: SINGLE MARRIED WIDOWED SEPARATED ANNULLED
PART 3. CONTACT INFORMATION

Mobile Numbers*: _ Telephone Number: _
Current Address*: _
Permanent Address*: _
Zip Code: _ _ Email Address: _
Mobile Number or E-mail used for Facebook Account:
_______________________ _______________________
(Signature of Applicant) (Date Accomplished)
“One Professional per Family”

PART 4. FAMILY INFORMATION
FATHER* LIVING DECEASED

First Name*: _ Birth Date:
Middle Name: _ Birthplace:
Last Name*: ___________________________ Occupation*:
Mobile Number/s*: _ _ Monthly Income*: __
Highest Educational Attainment*: _
Current Address*: _
MOTHER* LIVING DECEASED

First Name*: _ Birth Date: __
Middle Name: _ _ _Birthplace: __
Current Address*: _
GUARDIAN* (In case of deceased parents or absence of parents)

First Name*: ___________________________ Birth Date:
Middle Name: _ _ _Birthplace: __
Current Address*: _
COMBINED ANNUAL GROSS INCOME OF PARENTS/GUARDIAN*:

[Mother’s monthly income + Father’s monthly income + Guardian’s monthly income] * 12 months
PART 5. BASIC EDUCATION INFORMATION

Check if ALS Graduate Check if Senior High School Graduate *
School Type*: Public Private
Name of School Last Attended*:
Year of Graduation*:
School Address*: _
Senior Higher School Track*:
Arts Design Sports Tech-Voc-Livelihood Academic
Tech-Voc-Livelihood Strand:
Agri-Fishery Arts Home Economics Industrial Arts
Information and Communications Technology
Academic Track:
Accountancy, Business, and Management (ABM)
Humanities and Social Sciences (HUMSS)
Science, Technology, Engineering, and Mathematics (STEM)
General Academic Strand
_______________________ _______________________
“One Professional
“One Professional per
per Family”
Family”
PART 6. HEI INFORMATION

Name of School Enrolled
in or Intended to Enroll to*:
Type of School*: Public Private
School Address*: _
Preferred Degree Program*:
Refer to the BARMM Regional Priority Programs for AY 2020-21 at page 4
Have you taken an admission test/exam in this school*? YES NO
PART 7. SPECIAL ELIGIBILITY
Do you belong to any of the following*? Please select ONE:

Combatant
Child of a Combatant
Orphan of a Combatant
Surviving Spouse of a Combatant
Other
PART 8. DOCUMENTARY REQUIREMENTS

Citizenship Document*:
Certified true copy of Philippine Statistics Authority (NSA) Birth Certificate
Academic Documents* (Submit ONLY ONE of the following documents):

Form 138 for senior high school graduates before or in SY 2019-20
Accreditation and Equivalency Test Passer Certificate for an Alternative Learning System (ALS)
graduate before or in SY 2019-20
Financial Documents* (Submit AT LEAST ONE of the following documents):

Latest Income Tax Return (ITR) of parents or guardian
Certificate of Tax Exemption from the Bureau of Internal Revenue (BIR)
Certificate of Indigence either from his/her Barangay or Department of Social Welfare and
Development (DSWD)
Case Study report from DSWD
Latest copy of contract or proof of income (for children of Overseas Filipino Worker (OFW) and
seafarers)
Documents For Underprivileged, Disadvantaged, Marginalized, Poor and Low-income

Sector or Group* (Submit ANY of the following documents):
Single Parent ID from the Municipal or City Social Welfare and Development Office;
Certification of IP parent/s from the Ministry of Indigenous People’s Affairs (MIPA)-BARMM
Person with Disability (PWD) ID from the Municipal or City Social Welfare and Development Office
Senior Citizen ID of Parent/s or Guardian from the Municipal or City Office of the Senior Citizens
Affairs (OSCA)
Certifications of Death of Parents or Certification of Being an Orphan from the Barangay or
Municipality/City
Certification of Being an IDP from the Barangay or Municipality/City
Documents for the Combatants, Their Children, Orphans, or Surviving Spouses* (Submit
ONLY ONE of the following documents):
Certification from the MILF and MNLF Peace Mechanisms that the applicant is a former combatant
or his/her children
Certification from MILF and MNLF Peace Mechanisms that the applicant is an orphan,
his/her parent is a widow/widower due to the armed conflict, or is a surviving spouse
________________________ _______________________
“One
“One Professional
Professional per
per Family”
Family”
DECLARATION FORM*
I hereby certify that foregoing statements are true and correct. Any misinformation or withholding of information will automatically
disqualify me from the AHMEDPS Program. I am willing to refund the financial benefits received if such information is discovered after
the acceptance of the award.
I hereby express my consent for the MHTE- Higher Education to collect, record, organize, update or modify, retrieve, consult, use,
consolidate, block, erase or destruct my personal data as part of my information. I hereby affirm my right to be informed, object to
processing, access and rectify, suspend or withdraw my personal data and be indemnified in case of damages pursuant to the Republic
Act No. 10173 of the Philippines, Data Privacy Act of 2012 and its corresponding Implement Rules and Regulations.
(Signature over Printed Name of Applicant) (Date Accomplished)
Note: Fully accomplished form to be submitted to the MBHTE-Higher Education on or before AUGUST 14, 2020
BARMM REGIONAL PRIORITY PROGRAM for AY 2020-21
SCIENCE, TECHNOLOGY AND MATHEMATICS ENGINEERING
 Chemistry, Biochemistry, Chemistry with Material Science  Aeronautics Engineering

 Data Science, Statistics, Applied Statistics  Agricultural Engineering and Agricultural Bio-systems
 Entomology Engineering
 Information and Communication Technology  Petroleum Engineering
 Marine Science, Marine Biology, and Marine Technology  Mining Engineering
 Medical Laboratory Science  Geodetic Engineering
 Medical Technology and Radiology  Architecture, Civil, Design, and Structural Engineering
 Microbiology  Water Engineering
 Molecular Biology & Biotechnology  Sanitary Engineering
 Physics with Material Science & Engineering  Environmental Engineering
 Science Teaching (Biology, Chemistry, Physics, Physical  Industrial Engineering
Science, Technical and Livelihood Education with  Mechanical Engineering
Specialization in ICT)  Electrical Engineering
 Midwifery and Nursing  Computer Engineering
 Material Science & Engineering
 Biomedical Engineering
 Aquaculture Engineering
 Medical Engineering
AGRICULTURE, FORESTRY AND FISHERIES OTHER PROGRAMS FOR ECONOMIC

DEVELOPMENT
 Oceanography
 Environmental Science  Islamic Banking, Finance, and Economics
 Agribusiness  Business Management/Administration
 Agronomy  Cooperative Development
 Animal Science  Community Development
 Crop Science  Rural and Urban Development
 Plant Pathology  Economics
 Soil Science  Entrepreneurship
 Veterinary Medicine  Financial Management and Accountancy
 Agricultural Economics and Marketing  Hotel and Restaurant Management
 Animal Science and Animal Husbandry  International Relation Studies
 Horticulture
 Agricultural extension and communication
 Fisheries (Aquaculture, Capture Fisheries, Inland Fisheries,
Food Processing)
 Aquatic Science
“One Professional per Family”

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ACCESS TO HIGHER AND MODERN EDUCATION (AHME)

Application Serial Number: