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Expanded Tertiary Education Equivalency and Accreditation Program (ETEEAP)

University of Cebu (Main Campus)


Tel. No. 255 7777 local 176
Email: uc.eteeap@gmail.com

APPLICATION FORM
1X1
ID Picture
INSTRUCTIONS:

Please type or clearly print your answers to all questions. Provide complete and detailed
information required by the questionnaire. 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.
1. PERSONAL INFORMATION
1.1 Last Name First Name Middle Name

Maiden Name (If Applicable)

Address Zip Code

Cell No: Landline No: Birth Date:


Email Address: Birth Place:

Civil Status: Single Married Separated Widow(er) Divorced

Sex: Male Female Nationality: Filipino Others:


Language/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. Select three (3) degree programs which you
are most interested in pursuing, and rank them according to order of preference: 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 any more than three programs.

1.2 Degree Program or field being applied for:


First Priority:
Second Priority:
Third Priority:

1.3 Statement of your goals, objectives or purpose for applying for the degree.
(Please state your personal goal statement for obtaining the degree, and how you would expect the
ETEEAP’s system of accreditation through assessment to help you attain those objectives.)

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1.4 Indicate how much time you plan to devote for personal learning activities so that
you can finish the requirements in the prescribed period. Please specify the day and time of
your availability.

1.5 For overseas applicants, describe how you plan to obtain accreditation/equivalency.
(e.g. when you plan to come to the Philippines)

1.6 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) ________________
1.7 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

2. EDUCATION
This section will require you to provide information on your past formal, non-formal and
informal learning experiences.

A. Formal Education
Include only dates you started and finished elementary school. Indicate the name and
address of every school you attended, please indicate also whether the school is middle,
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, years is from 1st to 4th.

ELEMENTARY: Inclusive Dates of


Attendance
Name of School:

Address of School:

HIGH SCHOOL Inclusive Dates of


Attendance
Name of School:

Address of School:

If acquired High School through Philippine Educational Placement Test Equivalency


(PEPT)
Year Issued: Placement Grade or Year:

Name of School: Type of School:

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COLLEGE/VOCATIONAL
COURSE/DEGREE PROGRAM NAME & ADDRESS OF Inclusive Dates of
SCHOOL/INSTITUTION Attendance

Note: All entries should be supported by authenticated Xerox copy of appropriate


certificates/documents obtained from the institution through the program.

B. 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 Program Sponsoring Title of Certificate Inclusive Dates


Organization Obtained of Attendance

Note: All entries should be supported by authenticated Xerox copy of appropriate


certificates/documents obtained from the institution through the program.

C. Other Certification Examinations


Please give detailed information or certification examinations taken for vocational and
other skills.

Title of Certification Name/Address of Date Rating


Examination Certifying Agency Certified

Note: All entries should be supported by authenticated Xerox copy of appropriate


certificates/documents obtained from the institution through the program.

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3. PAID WORK AND OTHER EXPERIENCES
3.1 Work Designation 3.2 Name & Address of 3.3 Inclusive Dates
Company of Employment
(Day/Month/Year)
From To
Work # 1:

Work # 2:

Work # 3:

3.4 Terms/Status of Employment:


Work #1:
Work #2:
Work #3:
3.5 Name and Designation of Immediate Supervisor:
Work #1:
Work #2:
Work #3:
3.6 Reason for Moving on the Next Job Level or Transferring to another Job/Position:
Work #1:
Work #2:
Work #3:
3.7 Describe actual function and responsibilities in the position occupied:
Work #1:
Work #2:
Work #3:
3.8 In case of self-employment, name three (3) reference persons:

(Note: Use another sheet if necessary, following the above format.)

4. 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.

A. Academic Award

Award Conferred Name and Address of Date Awarded


Conferring Organization

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B. Community and Civic Organization Award/Citation
Award Conferred Name and Address of Date Awarded
Conferring Organization

C. Work-Related Award/Citation

Award Conferred Name and Address of Date Awarded


Conferring Organization

5. 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 works, products of visual 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.

1. Description : ___________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

2. Date Accomplished :
___________________________________________________________

3. Name and Address of Publishing Agency (if written, published work), or an


Association/Institution which can attest to the quality of the work.

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________
(Note: Use additional sheet if necessary, following the same format.)

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6. LIFELONG LEARNING EXPERIENCE

In this section, please indicate the various life experiences from which you must have
derived some learning experience. Please include here unpaid volunteer work.

A. Hobbies/Leisure Activities
Leisure activities which involve rating of skills for competition and other purposes (e.g.
“belt concept in Taek-won-do”) may also indicate your level for ease in evaluation. On the
other hand, watching Negosyete on a regular basis can be considered a learning
opportunity.
____________________________________________________________
___________________________________________________________
____________________________________________________________
___________________________________________________________
(Use Additional sheet if necessary)
 
B. Special Skills
Note down those special skills which you think must be related to the field of study you
want to pursue.

____________________________________________________________
___________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
(Use Additional sheet if necessary)

C. Work-Related Activities
Some work-related activities are occasions for you to learn something new. For
example, being assigned to projects beyond your usual job description where you learned
new skills and knowledge. Please do not include formal training programs you already
cited. However, you may include here experiences which can be classified as on-the-job
training or apprenticeship.

____________________________________________________________
___________________________________________________________
____________________________________________________________
___________________________________________________________
____________________________________________________________
______________________________________________________________________________
(Use Additional sheet if necessary)

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D. Volunteer Activities
List only volunteer activities that demonstrate learning opportunities, and are related to
the course you are applying for credit. (e.g. counseling programs, sports coaching, project
organizing and coordination, organizational leadership, and the like)
____________________________________________________________
___________________________________________________________
______________________________________________________________________________
(Use Additional sheet if necessary)

E. Travels: Cite places visited and purpose of travel


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 experience was
obtained from these travels and how it helped you become a better person.
____________________________________________________________
___________________________________________________________
____________________________________________________________
____________________________________________________________
(Use Additional sheet if necessary)

7. To sum up, please write an essay on the following topic, in the language you are most
comfortable with, not to exceed two (2) pages of short size bond paper:

If you finish your degree, how will this contribute to your personal development,
to the development of our community, your work place, society, and country?

I DECLARE UNDER OATH THAT, THE FOREGOING CLAIMS AND INFORMATION


I HAVE DISCLOSED ARE TRUE AND CORRECT. DONE IN (Address)

_____________________________________________________________,
ON THIS _____________ DAY OF _________________________________.

Signed:

_______________________________________________
PRINTED NAME and SIGNATURE OF APPLICANT

COMMUNITY TAX CERTIFICATE


NUMBER: ________________________
Date Issued: ________________________
Place Issued: ________________________

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