Republic of the Philippines

Department of Science and Technology

PHILIPPINE COUNCIL FOR INDUSTRY, ENERGY AND EMERGING
TECHNOLOGY RESEARCH AND DEVELOPMENT (PCIEERD)

4th & 5th Levels, Science Heritage Bldg., Science Community Complex,
Gen. Santos Ave., Bicutan, Taguig City
Tel. Nos. 553-86-37; 837-2071 locs 2101 ; Fax No. 837-6154

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PCIEERD
HUMAN RESOURCE DEVELOPMENT PROGRAM
(PCIEERD-HRDP)

APPLICATION FORM
(Print or type in block letters)
Name of applicant
Institutional affiliation
Office address
Contact number (mobile &
landline)
Email address
Program applying for:
[ ] Research Attachment
[ ] Faculty Immersion
[ ] Visiting Professorship
[ ] Attendance to conferences, seminars, trainings, workshops, etc.
Proposed sectoral priority area:
INDUSTRY
Electronic and semiconductor industries
Mining and minerals
Metals and engineering
Food processing
ENERGY
Alternative sources of energy
Transportation
Energy efficiency
EMERGING
Materials Science/ nanotechnology
Genomics
TECHNOLOGIES
Biotechnology
Information and communications technology
Space technology applications
Other emerging technologies
(specify)_____________________________
SPECIAL CONCERNS

Climate change adaptation

Environment

Disaster risk reduction management

PART I. PERSONAL INFORMATION

City/contact address
Birthdate
Gender
[ ] Male [ ] Female

Age
Civil status

Citizenship
[ ] Single [ ] Married [ ] Others _________

EDUCATIONAL BACKGROUND
Highest degree obtained
University/address
Inclusive dates
Honors received, if any
EMPLOYMENT DETAILS
Current designation
Inclusive dates
Brief description of duties and responsibilities (use additional sheet, if necessary)

PCIEERD HRDP Application Form (revised 2014)

Name and signature of applicant:

Date:

PCIEERD HRDP Application Form (revised 2014)