Lifelong Learning Experience

ETEEAP APPLICATION FORM

INSTRUCTIONS:

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 the declarations that you make are under oath. Discovery of any false claim in this application form will disqualify you form participating in this program.

I. PERSONAL INFORMATION

Indicate in the proper order your first name, middle name and family name. indicate your complete address to include building number / name, street name, district, city, and province when applicable. Indicate the telephone number and the area code for areas outside Metro Manila. Indicate complete birth date in this format: month, day, and year. Indicate place of birth, including city / municipality and province when applicable. Indicate all languages and dialects spoken such as English, Filipino, Chinese, Ibanag, Ilokano, Cebuano, Boholano, Bikolano, etc.

1.01. Name (Last Name, First Name, Middle Name)

___________________, _________________, ________________

1.02 Address : ___________________________________________________________

Zip Code ___________

1.03. Telephone No(s).: ________________
1.04. Birth Date : _____________________
1.05. Birthplace: _________________
1.06. Civil Status: Single Married Separated Widow(er) Divorced

1.07. Sex: Male Female Nationality: ______________
1.08. Languages and Dialects Spoken: ______________________
1.09. 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 1.10.1, 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 of two or more programs are of equal priority, indicate it also. Please do not write more than three programs. For 1.10.2, please state your personal goal statement of obtaining the degree, and how would you expect the ETEEAP’s system to accreditation through assessment to help you attain those objectives. For questions requiring Yes or No, kindly explain your answer. Please tick off appropriate answer for boxes provided below:

1.10 Degree program or field being applied for:

1.10.1.1 First priority : ___________________________________ 1.10.1.2 Second priority : ___________________________________ 1.10.1.3 Third priority : ___________________________________
1.10.2 Statement of your goals, objectives or purpose for applying the degree. ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________

1.10.3 Indicate how much time to plan to devote for personal learning activities so that you can finish the requirements in the prescribe program. Be specific. ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________

1.10.4 For overseas applicants, describe how you plan to obtain accreditation/equivalency (e.g. when you come to Philippines) ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________

1.10.5 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) ______________

1.10.6 How soon do you need to complete accreditation / equivalency? less than 1 year 1 year 2 years 3 years 4 years more than 5 years

II. EDUCATION

This section will require you to provide information on your past formal, non-formal and informal experiences.

A. Formal Education

Include only dates you started and finished elementary school. Indicate the name and address of every school you attended and the inclusive dates of attendance in each. In case you attended high school abroad, please indicate also whether the school is middle school, 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 of year level you were placed. Grades are from I to VI, Year 1st to 4th.

1. Elementary Name of School and Address: ______________________________________ Inclusive Dates of Attendance: _________________ to __________________

2. High School (If obtained outside the Philippine educational system, please indicate the type of school)

Name(s) and Address(es) of School(s) Attended
| |
|2.1 _________________________________________________ |
|_________________________________________________ |
|_________________________________________________ |
| |
|Inclusive Dates of Attendance: |
| |
|_____________ to _____________ |

Note: Use another sheet if necessary.
3. If acquired High School diploma through Philippine Educational Placement Test Equivalency.

Year Issued: ______________ Placement Grade or Year: _________________

4. Post Secondary Formal Education

|COURSE/ DEGREE PROGRAM ENROLLED |NAME OF INSTITUTION |SCHOOL YEAR |
|(e.g. Vocational, Technical) | | |
| | | |
| | | |
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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.

| |SPONSORING ORGANIZATION |DATE |TITLE OF CERTIFICATE OBTAINED |RATING |
|TITLE OF | | | | |
|TRAINING PROGRAM | | | | |
| | | | | |
| | | | | |
| | | | | |
| | | | | |

Note: All entries should be supported by authenticated xerox copy of appropriate certificates documents obtained from the institution through the program.

C. Other Certification Examinations

Please give detailed information on certification examinations taken for vocational and other skills.
| |NAME & ADDRESS OF CERTIFYING AGENCY |DATE CERTIFIED |RATING |
|TITLE OF CERTIFICATION EXAMINATION| | | |
| | | | |
| | | | |
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| | | | |

III. 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 the complete name and address of the company. Give name of known surviving immediate supervisor. Otherwise, give a name of a surviving person who can attest to 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 not be used to rate 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, please write down three personal references who can attest to your effectiveness in the trade or business you were involved in.

1.1 Post / Designation ______________________________________________________________________________
1.2 Inclusive Dates of Employment Day/Month/Year From __________________ to ______________________
1.3 Name and Address of Company ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________

1.4 Terms/Status of Employment ______________________________________________________________________________

1.5 Name and Designation of Immediate Supervisor ______________________________________________________________________________ ______________________________________________________________________________

1.6 Reason(s) for Moving On the Next Job ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________

1.7 Describe actual functions and responsibilities in position occupied: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________

1.8 In case of self-employment, name three (3) reference persons: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ (Use another sheet if necessary, following the above format.)

IV. 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 from work excellence, outstanding accomplishments, community services, etc.

Please write full title of award received. Indicate the name and most recent known address of the organization of institution conferring the award/honor/citation. Give the date the award was conferred.

A. ACADEMIC AWARD

|AWARD CONFERRED |Name and address of Conferring Organization |Date Awarded |
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B. COMMUNITY AND CIVIC ORGANIZATION AWARD/CITATION

|AWARD CONFERRED |Name and address of Conferring Organization |Date Awarded |
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C. WORK RELATED AWARD/CITATION

|AWARD CONFERRED |Name and address of Conferring Organization |Date Awarded |
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V. 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 and 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 qualifies as 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 a body or institution which can be called upon to corroborate your claim to this accomplishment.

| |
|1.1 Description: _____________________________________________________________ |
|________________________________________________________________________ |
|________________________________________________________________________ |
|________________________________________________________________________ |
|________________________________________________________________________ |
|________________________________________________________________________ |
|________________________________________________________________________ |
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|1.2 Date Accomplished: _______________________ |
|1.3 Name and Address of Publishing Agency (if written, published work), or an Association/Institution which can attest to the |
|quality of the work. |
|________________________________________________________________________ |
|________________________________________________________________________ |
|________________________________________________________________________ |
|________________________________________________________________________ |

(Use additional sheet if necessary, following the same format)

VI. LIFELONG LEARNING EXPERIENCE

In this section, please indicate the various life 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, Negosiyete on a regular basis can be considered a learning opportunity.

Leisure activities which involve rating of skills for competition and other purpose (e.g. “belt” concept in Tae-kwon-do) may also indicate 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 of swimming in accepted substitute for one Physical Education class requirement. Note down those special 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 related to the course are applying for credit. Select also those organizations which can be validated and they must be accredited by a government institution or the 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 the nature 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. ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________
VII. 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 your community, your work place, society and country.