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CHED Form E.5 (revised June 2001)
Unique Inst
FACULTY OR TEACHING STAFF IN HIGHER EDUCATION PROGRAMS
1st sem/Tri
Name of Institution:Region: _________
PLEASE READ THE ATTACHED INSTRUCTIONS BEFORE YOU FILL OUT THIS FORM.
Name ofFull-Time/SexPrimaryEducational Credential EarnedProfessionalTenure FacultyFacultyPart-TimeTeachingBaccalaureateMaster'sDoctorateLicenseofRankDisciplineEmployment
(LN, FN MI)(use Code)(M or F)(use Code)
(no abbreviation please)
(use Code)(use Code)(use Code)
EXAMPLE:DELA CRUZ, JUAN V.1M460100BS in MathematicsMS in MathematicsPh.D. Mathematics (18 units)24120
PLS. START YOUR ENTRY BELOW THIS ROW. INSERT MORE ROWS AS NEEDED.
Accomplished by: Certified CoDesignation: DesignationDate: Date:
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