U S J - R E T E E A P
(Expanded Tertiary Education Equivalency and Accreditation Program)
APPLICATION FORM
1” x 1”
PICTURE
INSTRUCTIONS HERE
Please type or clearly print your answers to all questions. Provide complete and detailed
information required by the questionnaire. Put a check mark in the appropriate box for specific
questions. All 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
Indicate in the proper order your last name, first name, and middle name. Indicate your
complete address to include building number/name, street name, district, city, and province when
applicable. Indicate the mobile and landline numbers and the area code for areas outside Cebu City.
Indicate complete birth details: including city/municipality and province when applicable. Indicate
all languages and dialects spoken such as English, Filipino, Chinese, Ibanag, Ilokano, Cebuano,
Boholano, Bikolano, etc.
1.1 Name (Last Name, First Name, Middle Name)
_________________________,____________________________,_______________________
1.2 City Address: _________________________________________________ Zip Code ________
Provincial Address: ____________________________________________ Zip Code ________
Present Address (if working abroad) ________________________________________________
_____________________________________________________________________________
Contact Person here in the Philippines and his/her Contact Number: _______________________
_____________________________________________________________________________
1.3 Your Cellphone #:__________________________ Telephone #:__________________________
1.4 Email Address #:___________________________ Fax #: ______________________________
1.5 Birth Date: _______________________________ Birthplace: ___________________________
1.6 Civil Status: Single Married Separated Widow(er) Divorced
1.7 Sex: Male Female Nationality: Filipino Others: ______________
1.8 Languages and Dialects Spoken: ___________________________________________________
1.9 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. For 1.9.1 select three 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 anymore than three
programs. For 1.9.2, 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. For question requiring Yes or No, kindly explain your answer. Please tick off
appropriate answer for the boxes provided below.
1.9.1. Degree program of field being applied for:
1.9.1.1 First Priority: _____________________________________________________
1.9.1.2 Second Priority: ___________________________________________________
1.9.1.3 Third Priority: ____________________________________________________
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1.9.2 Statement of your goals, objectives or purposes for applying for the degree.
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
1.9.3 Indicate how much time you plan to devote for personal learning activities so that you can
finish the requirements in the prescribed program. Specify the day and time of your
availability.
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
1.9.4 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)___________
1.9.5 How soon do you need to complete the 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 of your past formal, non-formal, and
informal learning experiences.
A. FORMAL STUDY
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, Year is from 1st to 4th.
I. ELEMENTARY
Name of School and Address: ________________________________________________
Inclusive Dates of Attendance: ___________________ to __________________________
II. HIGH SCHOOL
Name and Address of Schools Attended:
2.1 High School: _____________________________________________________
________________________________________________________________
Inclusive Dates of Attendance: ___________________ to _________________
2.2 If acquired High School through Philippine Educational Placement
Test Equivalency.
Year Issued: __________________ Placement Grade or Year: ____________
Name of School: _____________________ Type of School: _______________
NOTE: Use another sheet if necessary.
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III. COLLEGE/VOCATIONAL
COURSE/DEGREE SCHOOL
NAME AND ADDRESS OF INSTITUTION
PROGRAM YEAR
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 TITLE OF
SPONSORING
TRAINING DATE CERTIFICATE RATING
ORGANIZATION
PROGRAM OBTAINED
NOTE: All entries should be supported by authenticated xerox copy of appropriate
certificates/documents obtained from the institution through the program.
C. OTHER CERTIFICATION OF EXAMINATIONS
Please give detailed information on certification of examinations taken for vocational and other
skills.
TITLE OF
NAME AND ADDRESS OF
CERTIFICATION DATE CERTIFIED RATING
CERTIFYING AGENCY
EXAMINATION
3. PAID WORK AND OTHER EXPERIENCES
This section will describe the relevant work experiences you have and indicate the type of
learning obtained in the course of your employment. Please use the questionnaire below and write
your experiences in chronological order. Include concurrently held positions such as consultant, and
part-time employment as well.
Give full title for each position/occupation. When promoted, place the next position title in the
next set. Indicate inclusive dates you occupied the position. Give name of known surviving
immediate supervisor. Otherwise, give name of a surviving person who can attest your performance
as an employee in this position. Please explain why you have to move on the next job, or transfer to
another company. In case of a promotion, simply say so. The response you give to this question will
be used to rate of your appropriateness as a candidate to the program. Please give details of the
functions and responsibilities you performed in this position.
In case you were self-employed, pleas write down three personal references who can attest to
your effectiveness in the trade or business you were involved in.
WORK EXPERIENCES:
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(Please list down your work experiences from present to previous work experiences and attach
detailed job descriptions and use another sheet if necessary. )
3.3 INCLUSIVE DATES
3.1 WORK OF EMPLOYMENT
3.2 NAME & ADDRESS OF COMPANY
DESIGNATION (Day/Month/Year)
From To
Work
#1
Work
#2
Work
#3
Work
#4
3.4 Terms/Status of Employment
Work #1: ___________________________________________________________________
#2: ___________________________________________________________________
#3: ___________________________________________________________________
#4: ___________________________________________________________________
3.5 Name and Designation of Immediate Supervisor
Work #1: ___________________________________________________________________
#2: ___________________________________________________________________
#3: ___________________________________________________________________
#4: ___________________________________________________________________
3.6 Reason for Moving on the Next Job Level or Transferring to another Job/Position
Work #1: ___________________________________________________________________
#2: ___________________________________________________________________
#3: ___________________________________________________________________
3.7 Describe actual function and responsibilities in the position occupied:
Work #1: ___________________________________________________________________
#2: ___________________________________________________________________
#3: ___________________________________________________________________
3.8. In case of self-employment, name three (3) reference persons:
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
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.
Please write the full title of the award received. Indicate the name and most recent known address
of the organization of institution conferring the award/honor/citation.
A. ACADEMIC AWARDS (Elementary/High School/ College)
AWARD CONFERRED NAME & ADDRESS OF CONFERING DATE
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ORGANIZATION AWARDED
B. COMMUNITY AND CIVIC ORGANIZATION AWARD/CITATION
NAME & ADDRESS OF
AWARD CONFERRED DATE AWARDED
CONFERING ORGANIZATION
C. WORK RELATED AWARD/CITATION
NAME & ADDRESS OF
AWARD CONFERRED DATE AWARDED
CONFERING 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 work, products of visual and performing arts, exceptional
accomplishments in sports, social, cultural, 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.
Please provide a short description of your work/accomplishments and state why this qualities
has become a special accomplishment. For example, cooking regular meals will not qualify as a
special accomplishment; however an occasion where you were called upon to display skill and
knowledge in preparing a wide range of native regional delicacies is a special accomplishment,
implying possession of a sophisticated understanding and internalization of regional culture, science,
and art of regional cuisine, etc. Indicate date when special accomplishment was finished. Indicate
the name of the body or institution which can be called upon to corroborate your claim to this
accomplishment.
5.1 Description: _______________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
5.2 Date Accomplished: ______________________
5.3 Name and Address of Publishing Agency or an Association/Institution which ca attest to the
quality of the work: _________________________________________________________
_________________________________________________________________________
6. LIFELONG LEARNING EXPERIENCES
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In this section, please indicate the various life experiences from which you must have
derived some learning experiences. Please include here unpaid volunteer work.
A. Hobbies/Leisure Activities
Include only those leisure activities which can be considered learning opportunities. For
example watching television soap opera can not be considered a learning opportunity; however
watching Negosiyete on a regular basis can be considered a learning opportunity.
Leisure activities which involve rating skills for competition and other purposes (e.g.
“belt” in Tae-kwan-do) please indicate also your level for ease in evaluation.
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
________________________________________________________________________
B. Special Skills
A special skill can be considered as an acceptable substitute for a specific credit
requirement. For example, ability to demonstrate the various styles in swimming is an accepted
substitute for one Physical Education class requirement. Note down those skills which you think
must be related to the field of study you want to pursue.
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
________________________________________________________________________
C. Work-Related Activities
Some work-related activities are occasions for you to learn something new. For example,
being assigned to projects that are beyond your usual job description and requiring other types of
competence produces such results. Identify those tasks that can be considered as new and
through which you learned new skills and knowledge. Explain in detail what new knowledge in
other aspects of your work, thereby making you more effective on the job. Please do not
include, under this category, formal training programs you cited in section 2. However, you may
include here experiences which can be classified as on-the-job training or apprenticeship.
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
D. Volunteer Activities (including those activities participated in as a member of a
professional or civic organization):
Choose only volunteer activities that also demonstrate learning opportunities. The key to
selecting volunteer activities to be included here, is when those activities demonstrate new
knowledge and skills that is related to the course you are applying for credit. Select also those
organizations which can be validated, and they must be accredited by a government, institution
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or accrediting HEI. Volunteer activities which can be considered here are counseling programs,
sports coaching, project organizing or coordination, organizational leadership, and the like.
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
________________________________________________________________________
E. Travels: Cite places visited and purpose of travel.
Please enumerate places visited within and outside the Philippines. Include a write-
up 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.
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
7. SUMMATIVE
To sum up, please write an essay on the following topic, in the language you are most
comfortable with, not to exceed two 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 ________________, 20_____________.
Signed:
_____________________________________________
PRINTED NAME AND SIGNATURE OF APPLICANT
COMMUNITY TAX CERTIFICATE
NUMBER _____________________
Date Issued ____________________
Place Issued ____________________
