Attach here passport size picture taken within the last 3 months

SCHOLARSHIP APPLICATION FORM A.Y. 2017-2018 TYPE OF SCHOLARSHIP APPLIED FOR:

M.S. Local

Ph.D. Local

Postdoctoral Study Award

M.S. Overseas

Ph.D. Overseas

Master’s Sandwich Program

I.

Doctoral Sandwich Program

PERSONAL INFORMATION

a. Last Name

First Name

Middle Name

Permanent address No.

Street

City/Municipality

b. Province

c. Zip Code

Region

District

Passport No.

E-mail Address

d. Current Mailing Address e. Telephone Nos. (Landline/Mobile)

Fax. No.

f. Civil Status

Date of Birth

Age

Sex

g. Name of Father h.

Name of Mother

Name of Spouse Address Occupation Office Address Number of Dependents (Use additional sheet if necessary) Name of Dependent

II.

Birthday

Relation to Applicant

INFORMATION ON CHED & DOST SCHOLARSHIP AND OTHER PREVIOUSLY/CURRENTLY AVAILED OF SCHOLARSHIP/ GRANT DOST-PSHS HS

OTHERS CHED-TD CHED-SNPLP CHED-DCP OPAPP-CHED STUDY GRANT PROGRAM

B.S.

CHED-SGP-PA CHED-PAMANA CHED-SBGP DOST-RA 7687 DOST-MERIT DOST-JLAP OTHERS

YEAR OF AWARD

FIELD

UNIVERSITY/ SCHOOL

REMARKS

PCARI Scholarships Project

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CHED-FDP CHED-SEGS DOSTNSDB/NSTA DOST-ASTHRD DOST-ERDT

M.S.

DOSTCOUNCIL/SEI

PCARI OTHERS CHED-FDP CHED-SEGS DOSTNSDB/NSTA DOST-ASTHRD DOST-ERDT

Ph.D.

DOSTCOUNCIL/SEI

PCARI OTHERS

III. DEGREE PROGRAMS (For M.S./Ph.D. Applicants Only) New Applicant a.

University where you applied/ intend to enroll

b.

Course/Degree

Lateral Applicant a.

University enrolled in

b.

Course/Degree

c.

No. Of units earned

IV.

d. No. Of remaining units/sems

NON-DEGREE PROGRAMS (For Postdoctoral/Stand-alone Sandwich Programs Applicants Only)

POSTDOCTORAL STUDY AWARD New Applicant a.

University where you applied/ intend to enroll

b.

Degree Earned/University where you earned your degree

Lateral Applicant a.

University enrolled in

b.

Degree Earned/University where you earned your degree

c.

Research/Project Area

STAND-ALONE SANDWICH PROGRAMS a. University enrolled in b.

Degree Earned/University where you earned your degree

c.

Research/Project Area

d.

Overseas University where he/she will conduct the dissertation

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PCARI Scholarships Project

a.

V.

CAREER/EMPLOYMENT INFORMATION Present Employment Status:

a.1

For those who are presently employed*

Permanent

Contractual

Self-employed

Unemployed

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Probationary

Position Company Address

a.2

E-mail

Website

Telephone No.

Fax No.

For those who are self-employed Business Name Address Email/Website

Telephone No.

Type of Business

Years of Operation

Fax No.

*Once accepted into the scholarship program, the scholar must obtain permission to take a Leave of Absence (LOA) from his/her employer and become a full-time student. The scholar must submit a letter from his/her employer approving the LOA.

b.

Narrative on Applicant’s Current Work, Outstanding Qualities, Career and Research Plans (Write in separate sheet attached to this form)

b.1

Provide a narrative of not more than one thousand (1000) words, describing the applicant’s current work or project (or research) that s/he worked on and his/her contribution towards the completion of the project.

b.2

Provide a narrative of not more than five hundred (500) words, describing the qualities that make (you) the applicant outstanding in a highly competitive process (e.g., academic excellence, development potential, financial need, etc.) For Master’s Scholarship applicant, a narrative, not more than five hundred (500) words, describing his/her intended research area and what the applicant intends to do (e.g., work, business, etc.) after earning his/her graduate degree. For Doctoral Scholarship and Postdoctoral Fellowship applicants, a narrative, not more than 500 words, describing his/her intended research area, e.g., a “Statement of Purpose”.

VI.

RESEARCH AND DEVELOPMENT INVOLVEMENT (last five years) Use additional sheet if necessary.

FIELD AND TITLE OF RESEARCH

VII.

LOCATION/DURATION

NATURE OF INVOLVEMENT

PUBLICATIONS (last five years) Use additional sheet if necessary. TITLE OF ARTICLE/PUBLICATION

VIII.

FUND SOURCE

PLACE/YEAR OF PUBLICATION

NATURE OF INVOLVEMENT

AWARDS RECEIVED Use additional sheet if necessary. 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___________________

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PCARI Scholarships Project

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________________________________________________________________________________________________________________________ CHECKLIST OF REQUIRED DOCUMENTS SUBMITTED (for staff use only)   

Curriculum vitae covering personal, educational (including research projects if applicable),and professional (type of work and position occupied) background. Recommendation letter from three (3) past professors or supervisors Birth certificate (original NSO copy and photocopy)



Admission letter (Note: For overseas scholarship, admission letter will only be required from pre-qualified applicants.)  Medical Cerificate from a licensed physician indicating PRC License No.  Grades or official transcript of records  Diploma or certificate of graduation Certification of no pending cases from  NBI  Employer (University for new graduates)

Staff’s Signature Date: __________________

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