CERTIFICATION OF RENDERED RETURN SERVICE
This is to certify that <<Name of Scholar>> has rendered return service with our institution from
<<Start Date>> to <<End Date>>, covering <<#>> years, in accordance with at least 1:1 return
service policy of the Commission on Higher Education.
Below is a summary of the scholarship and the return service:
SCHOLAR NAME: _______________________________ UNID: _________________________
SHEI NAME: ______________________________________________________________________
DHEI NAME: ______________________________________________________________________
PROGRAM: ______________________________________________________________________
TOTAL DURATION OF STUDY: _____ Regular Terms _____ Special / Non-Regular Terms equivalent
to _____ years and _____ months
Academic Year Term
Start ⭘ AY 2016-2017 ⭘ Term 1
⭘ AY 2017-2018 ⭘ Term 3
⭘ Term 2
⭘ Term 4
End ⭘ AY 2016-2017 ⭘ ⭘ Term 1
AY 2019-2020 ⭘ Term 3
⭘ AY 2017-2018 ⭘ ⭘ Term 2
AY 2020-2021 ⭘ Term 4
⭘ AY 2018-2019 ⭘
AY 2021-2022
TOTAL DURATION OF RETURN SERVICE IN YEARS: _________ YEARS
Start of Return Service: __________ (MM) / _____________ (YYYY)
End of Return Service: __________ (MM) / _____________ (YYYY)
This is being issued as a requirement for the final clearance from the Commission.
<<Name of Head of Institution>>
<<Position>>
<<Name of School>>