Professional Regulation Commission

APPLICATION FOR ACCREDITATION OF CPD PROGRAM

CPD COUNCIL OF/FOR ELECTRONICS ENGINEERING

Part I. General Information

Name of Provider: IECEP, INC
Accreditation No.: ECE-2009-001 Expiration Date: JULY 2021
Contact Person: ELISSA MAE A. BAUTISTA Designation: CPD SECRETARIAT
Contact No.: (8)687-7187 Date of Application:
E-mail add.: iecep.cpd@gmail.com
Proposed Program:

Conference Seminar Online Learning

Convention Workshop Educational/Study Tour
Forum Training Program Others: _____________

Title of the Program:

Date to be offered: Duration: Time:

Venue and Address: No. of times program to be conducted:

Course Description:

Objectives:

Number of Target Participants: Registration fee to be collected:

Part II. Acknowledgment

I hereby certify that the above information written by me are true and correct to the best of my knowledge
and belief. I further authorize PRC and other agencies to investigate the authenticity of all the documents
presented.

I am agreeing to the PRC Privacy Notice and giving my consent to the collection and processing of my
personal data in accordance thereto.

_________________________________
(Signature Over Printed Name)
__________________________
Position
_____________________
Date
Part III. Assessment
Regulation Division: Cash Division:
Assessed by : ___________________ Amount : ___________ O.R. No.: ____________
Date : ___________________ Date : ____________________
Remarks : ___________________ Issued by : ____________________
Part IV. Action taken by the CPD Council

Approved for _____ credit units Accreditation No. _______________

Deferred pending compliance ____________________________________
_ ___________________________________________________________
Disapproved due to ____________________________________________
____________________________________________________________

_____________________________
Chairperson

____________________________ _____________________________
Member Member
Date:____________________

CPDD-02
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June 29, 2020
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 PROCEDURE FOR ACCREDITATION OF CPD PROGRAM
Step 1. Secure application form at Regulations Division of any of the PRC Regional Offices or download at
PRC website (www.prc.gov.ph).
Step 2. Fill-out Application Form and attach supporting documents listed hereunder. Provide one (1)
set for receiving copy.
Step 3. Proceed to Regulations Division of any of the PRC Regional Offices for checking and assessment.
Step 4. If the assessment is favorable, pay prescribed fee of One Thousand Pesos (₱ 1,000.00) per
program offering. Government agencies and instrumentalities offering CPD Programs free of
charge, do not have to pay a fee. If not favorable, go back to Step 3.
Step 5. Submit Application Form with attached supporting documents and photocopy of official receipt to
Regulations Division of any of the PRC Regional Offices, at least fifteen (15) working days prior to
offering.
Step 6. Follow-up the application ten (10) working days after submission at CPD Division (Central Office),
telephone numbers (+632) 8810-84-15 (PRC-PICC), or email at cpdd.applications@gmail.com
CHECKLIST OF REQUIREMENTS
Supporting Documents
[ ] Instructional Design as prescribed by the relevant Board.
[ ] Program of Activities showing time/duration of topics/workshop and resource persons with position
and office, and evaluation period.
[ ] Evaluation method or tool that measures the learning gained by the participants specific and
appropriate to course objectives set
[ ] Resume of resource persons relevant to CPD program applied for.
[ ] Photo copy of valid Professional Identification Card of resource persons if registered professional.
Otherwise, submit photocopy of government-issued or company Identification Card.
[ ] Valid Special Temporary Permit if the resource person is a foreigner and if engagement is more than
three (3) days or there is physical contact with patients in the case of medical and allied professions.
[ ] Breakdown of expenses for the conduct of the CPD program.
[ ] For Online Learning, Declaration of Minimum Technical Requirements (e.g. Operating System,
Processor, Memory, Browser, Internet Connection, etc.)
Additional Requirements
[ ] Short brown envelope for the Certificate of Accreditation
[ ] One (1) set of metered documentary stamps worth Twenty-Five Pesos (₱ 25.00) each to be affixed to
the Certificate of Accreditation. (Available at PRC Customer Service and PRC Regional Offices)
[ ] Soft copy of the Application including supporting attachments in PDF format saved in flash drive.
Note:
1. Representative/s filing application/s for accreditation and claiming the Certificate of Accreditation on
behalf of the applicant must present a letter of authorization and valid identification cards of both the
authorized signatory and the representative. In the case of national organizations with chapters/councils,
endorsement from the national board.
2. If additional requirement/s is/are needed, a period of another 10 working days is given to submit the
same. Failure to comply within the period shall be construed as abandonment of application and the
prescribed fee shall be forfeited in favor of the government.
3. The CPD Council shall have the right to specify additional requirements if deemed necessary and
appropriate.

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June 29, 2020
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 Professional Regulation Commission

INSTRUCTIONAL DESIGN

CPD COUNCIL OF/FOR ELECTRONICS ENGINEERING

PROGRAM TITLE:
___________________________________________________________________________________________________________

PROGRAM DESCRIPTION:
___________________________________________________________________________________________________________

PROGRAM OBJECTIVES/LEARNING OUTCOMES:

Evaluation Method or
Topics To Be Teaching Methods and
Specific Objectives Learning Outcomes Time Allotment For Tools To Be Used to
Discussed / Aids Needed For Each
of the Program per Topic Each Topic Measure the Program
Resource Person1 Topic
Objectives2

1 2
Attach Program of Activities and Attach Evaluation Tool.

Resume of Resource Person

REMARKS:
___________________________________________________________________________________________________________
__________________________________

Prepared by: _______________________________________

Date : ______________________________

TO BE DETERMINED BY THE CPD COUNCIL:

I. PROGRAM LEVEL: BASIC ADVANCED HIGHLY ADVANCED

II. APPROVED CREDIT UNITS: ______________________

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June 29, 2020
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 Institute of Electronics Engineers of the Philippines, Inc.
7th F, Suite 712 Cityland Shaw Tower, Shaw Blvd. corner St. Francis Street, Mandaluyong City, Philippines
Tel. No.: (632) 687-7187 E-mail: iecep.secretariat@gmail.com Website: www.iecep-national.org

Course Outline
Title of Seminar : _______________________________________________________________________

Instructor/Lecturer: ____________________________________________________________________

Total no. of Hours of Seminar: ____________________________________________________________

Description:
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
__________________________________________________________________.

Objectives:
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
____________________________________________________________________________

Synopsis:________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
______________________________________________________________________

Course Outline:
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________

CPDD-02
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June 29, 2020
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 OUTLINE/PROGRAM OF ACTIVITIES

Date: Time:

CPD Program Title:

Topic/s:

ACTIVITIES

Time Activity Duration

CPDD-02
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June 29, 2020
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EVALUATION METHOD/TOOL FOR PARTICIPANTS

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EVALUATION METHOD/TOOL FOR RESOURCE PERSON

CPDD-02
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 Professional Regulation Commission

RESUME OF RESOURCE PERSON

CPD COUNCIL OF/FOR ELECTRONICS ENGINEERING

RECENT 2X2
PICTURE (color
photo with white
Principal Alternate Substitute background)

Part I. Personal Circumstances

Name: Nickname:

Residence Address: Contact Details

Landline No.:
Business Address: Mobile No. 1:
Mobile No. 2:
Email Add.:
Nationality/Citizenship:
Note: The CPD Council shall be informed of any change/s on resource person/s at least 10 days
before the CPD program offering. Substitute resource person may submit this duly accomplished
form three (3) days from the completion of the CPD program.
Part II. Track Record
Specialization Sub-Specialization
Major
Competency
Areas
Relevant Seminars/Training Programs Relevant Seminars/Training Programs
Conducted in the last five (5) years Attended in the last five (5) years
Date Title of the Program Date Title of the Program

Major Achievements, Citations, Recognition and Awards

Date Title Awarding Body

Part III. Education and Employment

Educational Name of Inclusive
Address Degree Earned
Background School/University Dates

College

Post-
Graduate
Position Agency/Company Inclusive Dates
Work
Experience:
Five (5) most
recent

Part IV. Other Relevant Information

Profession/s License Issued Valid
No. on: until:
AIPO Membership National/Chapter Position Date

CPDD-02
Rev. 04
June 29, 2020
Page 8 of 14
 Other Major Affiliations
National/Chapter Position: Date
(Professional, Civic)

I hereby certify that the above information

written by me are true and correct to the best of
my knowledge and belief. I further authorize PRC
and other agencies to investigate the authenticity
of all the documents presented.

I am agreeing to the PRC Privacy Notice and

[Electronically paste here your scanned PRC
giving my consent to the collection and
ID for professionals or other government-
processing of my personal data in accordance
issued or company ID]
thereto.

__________________________________
Signature Over Printed Name
_________________________
Date

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June 29, 2020
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 TITLE OF ACTIVITY:
TYPE OF ACTIVITY:
SEMINAR/WORKSHOP /FORUM LEARNING SESSIONS IN THE CONVENTION EDUCATIONAL TOUR
OTHERS (Please specify)
DATE:
VENUE:
TARGET NO. OF PARTICIPANTS:

BREAKDOWN OF EXPENSES:

EXPENSE ITEMS DETAILS OF THE EXPENSES AMOUNT

1. Venue
2. Meals

3. Honoraria
a. Speaker (or panel of
experts)
b. Facilitator
c. Moderator/Master of
Ceremony
d. Secretariat
4. Itemized materials (e.g
handbook/handouts, certificates, pencil
and papers, seminar kits, ink for printers)

5. Advertising expenses
6. Transportation
a. Speaker/s
b. Staff
7. Accommodation (for the
speaker)
8. Processing Fee
( Accreditation Fee)
9. Supplies and Equipment
10. Laboratory
11. VAT (12%)
12. Entrance fees (for museum,
heritage/historical sites, cultural centers,
exhibits, geographical sites, other sites,
etc.)
13. Tour guide/ Facilitator’s
fee
14. Miscellaneous (Please
specify)

TOTAL EXPENSES:_____________________________________

_____________________________
Signature Over Printed Name
_____________________________
Position
_____________________________
Date

Computation:
Fees collected per participant        xx 
xTotal expected participants           xx
Total Revenue                                 xx
-Total Expenses                             (xx)  
Profit                                                xx should not exceed 20% of total 
                                                                                  REVENUE

 DECLARATION OF MINIMUM TECHNICAL REQUIREMENTS

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URL

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TERMS OF AGREEMENT

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SAMPLE CERTIFICATE

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