APPLICATION

Date:

I/We the following undersigned researcher(s) with the research title:

______________________________________________________________________________________________ would
like to apply for ( ) Proposal Oral Defense ( ) Final Oral Defense ( ) Re-Defense ( ) Ethics Review and Validation.

Hereto attached are the following:

1. Four (4) copies of manuscript

The Researcher(s),

__________________________, _________________________________, ______________________________

Recommended by: ______________________________________

Signature Over-printed Name of Thesis Adviser

Amount
Fees Proposal Ethics Review Final Re-Defense
Defense and Validation Defense
Adviser’s Fee 500
Panelist’s Fee (x3 members) 150=450
Research Ethics Review Fee/RI Validation
Forms (Consultation and Recommendation,
Application, Letter to Conduct Study, Minutes of the
Defense, Ethics Checklist, Evaluation, Certifications,
and Acceptance and Approval)
Statistician/Data Analyst’s Fee 300
Grammarian’s Fee 300
Total 1,550

Attested by: _____________________ Approved: ___________________________ ____________________

Accounting/Date Program Head/Coordinator/Date Date of Defense/Review

Note: The researcher(s) shall bring the Official receipt during defense or ethics review.

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Acknowledgement
Date: ______________________

Name of Researcher(s); ________________________________________________________________________________

Title: _______________________________________________________________________________________________

Date/Time of Defense: ________________________________ Venue: __________________________________________

Scheduled by: ________________________

Signature Over-Printed Name

F-RES-009
Rev. 0 10/10/2019