ࡱ> + 9bjbj¦ ĨDhĨDh&0o66|8Lv$$$5L7L7L7L7L7L7L$,OQf[LT&!$T&T&[L pL***T&:5L*T&5L**REHh@J/Ր3&9I!LL0LWIbHR'HR<JHRJh$Zk$@*$4$u$$$[L[Lv($$$LT&T&T&T&HR$$$$$$$$$6X : 4 ɩ Tuguegarao City, Cagayan 3500 EXPANDED TERTIARY EDUCATION EQUIVALENCY AND ACCREDITATION PROGRAM   INSTRUCTIONS Please type or clearly print your answers to all questions. Provide complete and detailed information required by the questionnaire. Put a check mark in the appropriate box for specific questions. All the declarations that you make are under oath. Discovery of any false claim in this application form will disqualify you from participating in the program. PERSONAL INFORMATION Indicate in the proper order your last name, first name and middle name. Indicate your complete address to include building number/name, street name, district, city and province when applicable. Indicate the telephone number and the area code for areas outside Metro Manila. Indicate complete birth date in this format: month, day, year. Indicate place of birth, including city/municipality and province when applicable. Indicate all languages and dialects spoken such as English, Filipino, Ibanag, Ilokano, Cebuano, Boholano, Bikolano, etc. Name: (Last Name, First Name, Middle Name) Address: Zip Code: Telephone / Mobile No(s): Birth Date: Birth Place:  Civil Status: Single Married Separated Widow Divorced Sex: Male Female Nationality: Filipino Others: Languages and Dialects Spoken: Learning Objectives: Under this section, you will be asked to assess your goals and capacity to undertake the program. Please answer all the questions completely. For 1.10.1, select three degree programs which you are most interested in pursuing, and rank them according to order of preferences: first, second and third. In case you do not have any second or third priority, leave them blank. In case two or more programs are of equal priority, indicate it also. Please do not write more than three programs. For 1.10.2, please state your personal goal statement for obtaining the degree, and how would you expect the ETEEAPs system to accreditation through assessment to help you tick off appropriate answer for the boxes or field provided below: Degree program or field being applied for: First priority: Second priority: Third priority: Statement of your goals, objectives or purposes for applying for the degree: Indicate how much time you plan to devote for personal learning activities so that you can finish the requirements in the prescribed program. Be specific. For overseas applicants, describe how you plan to obtain accreditation / equivalency. (e.g. when you plan to come to the Philippines) Who will pay for the cost of obtaining your accreditation?  Self financed Scholarship / grant  Company / employer financing Support from a member of the family  Loan Others (please specify): How soon do you need to complete accreditation / equivalency?  Less than 1 year 1 year  2 years 3 years  4 years more than 5 years EDUCATION This section will require you to provide information on your past formal, non-formal and informal learning experiences. Formal Education Include only dates you started and finished elementary school. Indicate the name and address of every school you attended and the inclusive dates of attendance in each. In case you attended and the inclusive dates of attendance in each. In case you attended high school abroad, please indicate also whether the school is middle school, junior or senior high school, and the inclusive dates of attendance in each of them. For those who obtained equivalency through PEPT, please indicate the date they were certified, and the grade or year level you were placed. Grades are from I to VI, Year is from 1st to 4th. Elementary Name of School & Address: Inclusive Dates of Attendance: High School (If obtained outside Philippine educational system, please indicate the type of school.) Name(s) and Address(es) of Schools Attended  Note: Use another sheet if necessary. If required High School diploma through Philippine Educational Placement Test Equivalency. Year Issued: Placement Grade or Year: Post Secondary Formal Education COURSE/DEGREE PROGRAM ENROLLED (e.g. Vocational, Technical)NAME OF INSTITUTIONSCHOOL YEAR Note: All entries should be supported by authenticated Xerox copy of appropriate certificates / documents obtained from the institution through the program. Non formal Education Non-formal education refers to structured and short-term training programs conducted for a particular purpose such as skills development values orientation, and the like. TITLE OF TRAINING PROGRAMSPONSORING ORGANIZATIONDATETITLE OF CERTIFICATE OBTAINEDNATURE OF PARTICIPATION (Trainer, Participant, Facilitator, etc.) Note: All entries should be supported by authenticated Xerox copy of appropriate certificates / documents obtained from the institution through the program. Other Certification Examinations Please give detailed information on certification examination taken for vocational and other skills. TITLE OF CERTIFICATION EXAMINATIONNAME & ADDRESS OF CERTIFYING AGENCYDATE CERTIFIEDRATING PAID WORK AND OTHER EXPERIENCES This section will described the relevant work experiences you have and indicate the type of learning obtained in the course, of your employment. Please use the questionnaire below and write your experiences in chronological order. Include concurrently help positions such as consultant, and part-time employment as well. Give full title for each position / occupation. When promoted, place the next position title in the next set. Indicate inclusive dates you occupied the position. Give the complete name and address of the company. Give name of known surviving immediate supervisor. Otherwise, give a name of surviving person who can attest to your performance as an employee in this position. Please explain why you have to move on to next job, or transfer to another company. In case of a promotion, simply say so. The response you give to this question will not be used to rate your appropriateness as a candidate to the program. Please give details of the functions and responsibilities you performed in this position. In case you were self-employed, please write down three personal references who can attest to your effectiveness in the trade or business you were involved in. Post / Designation: Inclusive Date of Employment Day / Month / Year From: to Name and Address of Company Terms / Status of Employment Name and Designation of Immediate Supervisor Reason(s) for Moving on to Next Job Described actual functions and responsibilities in position occupied: In case of self employment, name three (3) reference persons: (Use another sheets if necessary, following the above format) HONORS, AWARDS AND CITATIONS RECEIVED In this section, please describe all the awards you have received from schools, community and civic organizations, as well as citations for work excellence, outstanding accomplishments, community service, etc. Please write full title of the award received. Indicate the name and most recent known address of the organization or institution conferring the award / honor / citation. Give date the award was conferred. ACADEMIC AWARD AWARD CONFERREDName & Address of Conferring OrganizationDate AwardedCOMMUNITY AND CIVIC ORGANIZATION AWARD / CITATION AWARD CONFERREDName & Address of Conferring OrganizationDate Awarded WORK RELATED AWARD / CITATION AWARD CONFERREDName & Address of Conferring OrganizationDate Awarded CREATIVE WORKS AND SPECIAL ACCOMPLISHMENTS: In this section, enumerate the various creative works you have accomplished and other special accomplishments. Examples of these are inventions, published and unpublished literary fiction and non-fiction writings, musical work, products of visual and performing arts, exceptional accomplishments in sports, social, cultural and leisure activities, etc. which can lead one to conclude the level of expertise you have obtained on certain fields of interest. Include also participation in competitions and prizes obtained. Please provide a short description of your work / accomplishments and state why this qualities as a special accomplishment. For example, cooking regular meals will not qualify as a special accomplishment; however an occasion where you were called upon to display skill and knowledge in preparing a wide range of native regional delicacies is a special accomplishment, implying possession of a sophisticated understanding and internalization of regional culture, science and art of regional cuisine, etc. Indicate date when special accomplishment was finished. Indicate the name of a body or institution which can be called upon to corroborate your claim to this accomplishment.  (Use additional sheet if necessary, following the same format.) LIFELONG LEARNING EXPERIENCES In this section, please indicate the various life experiences from which you must have derived some learning experience. Please indicate here unpaid volunteer work. Hobbies / Leisure activities: Include only those leisure activities which can be considered learning opportunities. For example, watching television soap opera cannot be considered a learning opportunity; however, watching. Negosiyete on a regular basis can be considered a learning opportunity. Leisure activities which involve rating of skills for competition and other purposes (e.g. belt concept in Tae-kwon-do) may also indicate your level for ease in evaluation. Special Skills: A special skill can be considered as an acceptable substitute for a specific credit requirement. For example, ability to demonstrate the various styles of swimming is an accepted substitute for one Physical Education class requirement. Note down those special skills which you think must be related to the field of study you want to pursue. Work Related Activities Some work-related activities are occasions for you to learn something new. For example, being assigned to projects that are beyond your usual job description and requiring other types of competence produces such results. Identify those tasks that can be considered as new and through which you learned new skills and knowledge. Explain in detail what new knowledge in other aspects of your work, thereby making you more effective on the job. Please do not include, under this category, formal training programs you cited in section 2. However, you may include here experiences which can be classified as on-the-job training or apprenticeship. Volunteer Activities (including those activities participated in as a member of a professional or civic organization): Choose only volunteer activities that also demonstrate learning opportunities. The key to selecting volunteer activities to be included here is when those activities demonstrate new knowledge and skills that related to the course are applying for credit. Select also those organizations which can be validated and they must be accredited by a government institution or the accrediting HEI. Volunteer activities which can be considered here are counseling programs, sports coaching projects organizing or coordination, organizational leadership, and the like. Travels: Cite places visited and purpose of travel. Please enumerate places visited within and outside the Philippines. Include a write-up of the nature of travel undertaken, whether for leisure, employment, business or other purposes. State in clear terms what new learning experiences were obtained from these travels and how it helped you become a better person. To sum up, please write and essay on the following topic, in the language you are most comfortable with, not to exceed two pages of short size bond paper. 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