DEPARTMENT OF SCIENCE AND TECHNOLOGY
SCIENCE EDUCATION INSTITUTE Bicutan, Taguig City
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INFORMATION SHEET for the
ACCELERATED SCIENCE & TECHNOLOGY HUMAN RESOURCE DEVELOPMENT PROGRAM 2010-2011 GRADUATE SCIENCE AND TECHNOLOGY SCHOLARSHIPS TYPE OF SCHOLARSHIP APPLIED FOR: MS FORM A
I. PERSONAL INFORMATION a. Last Name b. Permanent Address c. Zip Code d. Current Mailing Address e. Telephone Nos. (Landline/Mobile) f. Civil Status g. Name of Parents Address II. INFORMATION ON DOST SCHOLARSHIP PREVIOUSLY/CURRENTLY AVAILED OF
YEAR OF AWARD HS FIELD UNIVERSITY/SCHOOL SCHOLARSHIP PSHS OTHERS: __________ NSTA/NSDB RA 7687 BS MERIT JLAP OTHERS: __________ NSTA/NSDB ASTHRD MS ERDT COUNCIL/SEI OTHERS: __________ NSTA/NSDB ASTHRD PhD ERDT COUNCIL/SEI OTHERS: __________ REMARKS
PhD
Thesis Grant
Dissertation Grant
First Name No. Street District City/Municipality E-mail Address
Middle Name Province
Passport No.
Fax No. Age Sex (Mother)
Date of Birth (Father)
III. GRADUATE SCHOLARSHIP INTENTIONS DATA
Applicants for graduate program should elect to go to another university if his/her 1st (BS) and 2nd (MS) degrees were taken from the same university to avoid inbreeding.
New Applicant a. University where you applied/intend to enroll 1ST CHOICE: for graduate studies 2ND CHOICE: 3RD CHOICE: b. Course/Degree Lateral Applicant a. University enrolled in b. Course Degree c. Number of units earned d. No. of remaining units/sems
Thesis/Dissertation Applicant (Please fill-up also information on Lateral Applicant) Has your research topic been approved by the panel? Yes No Title Date of last enrollment in thesis/dissertation
IV. CAREER/EMPLOYMENT INFORMATION a. Present Employment Status: ( ) Permanent ( ) Contractual ( ) Probationary ( ) Self-employed ( ) Unemployed a.1 For those who are presently employed Position Name of Company/Office Address of Company/Office E-mail Telephone No. a.2 For those who are self-employed
Business Name Address Email/Website Telephone No. Fax No.
Length of Service
Website Fax No.
Type of Business b. CAREER PLANS (Write in the attached sheet) b1. Briefly discuss your proposed research areas b2. Future Plans (After Graduation)
Years of Operation
V. RESEARCH AND DEVELOPMENT INVOLVEMENT (last five years) Use additional sheet if necessary.
FIELD AND TITLE OF RESEARCH LOCATION/DURATION FUND SOURCE NATURE OF INVOLVEMENT
VI. PUBLICATIONS (last five years) Use additional sheet if necessary.
TITLE OF ARTICLE/PUBLICATION PLACE/YEAR OF PUBLICATION NATURE OF INVOLVEMENT
VII. AWARDS RECEIVED
TITLE OF AWARD AWARD GIVING BODY YEAR OF AWARD
I hereby certify that all information given above are true and correct to the best of my knowledge.
Signature of Applicant Date
CHECKLIST OF REQUIRED DOCUMENTS SUBMITTED (for staff use only)
Birth Certificate
Certified True Copy of Grades/Transcript of Records. Recommendation from two former professors in college If employed, must be recommended by the head of agency Certification from a licensed physician indicating his PRC No., as to health status.
Valid NBI Clearance One passport size picture Certification of Admission in the University where you intend to enroll.* Result of University Evaluation Sheet for Admission in the graduate program signed by the Dean of Graduate Studies/School Program of study approved by the graduate school* *must be submitted as a requirement for the awarding of scholarships
Deadline for Submission of Application : First Semester - May 14, 2010 Second Semester - September 17, 2010
ACCELERATED SCIENCE & TECHNOLOGY HUMAN RESOURCE DEVELOPMENT PROGRAM 2010-2011 GRADUATE SCIENCE AND TECHNOLOGY SCHOLARSHIPS
Name of Applicant: ___________________________________________ Date: CAREER PLANS b1) Briefly discuss your proposed research areas
b2) Future Plans (After Graduation)
