ENGINEERING RESEARCH AND DEVELOPMENT FOR TECHNOLOGY (ERDT) SCHOLARSHIP PROGRAM APPLICATION FORM

Transcription

1 ENGINEERING RESEARCH AND DEVELOPMENT FOR TECHNOLOGY (ERDT) SCHOLARSHIP PROGRAM Attach here 1 latest passport size picture APPLICATION FORM TYPE OF SCHOLARSHIP APPLIED FOR: ME MS DE PhD Program of Study: (e.g., Civil Engineering) Research Areas of Interest: (1) (2) (3) QUALIFICATIONS: 1. Must be a Filipino Citizen 2. Must not be over 45 years of age 3. Must have a BS degree in engineering or related field (for MS applicants) 4. Must have a MS degree in engineering or related field (for PhD applicants) 5. Must be in good health 6. Must not have criminal/administrative cases (NBI certification is required) 7. Must be enrolled as a full-time graduate student 8. Must not have other scholarship contract 9. Must be willing to render the required service obligation equivalent to the length of time that the scholar enjoyed the scholarship One year of service for every year of scholarship or a fraction thereof 10. Must have a full-time commitment to the scholarship and must not be engaged in any form of employment during the scholarship. Deadline of Submission of Application: First Semester April 11 (tentative) Second Semester September 5 CHECKLIST OF REQUIRED DOSUMENTS (for staff use only) Birth Certificate (Photocopy) Certified True Copy of Grades/Transcript of Records Recommendation letter from 3 past professors or supervisors (see attached sheet) Narrative essays If employed, must be recommended by the head of agency and secure permission to take a leave of absence while on scholarship Medical Certificate as to health status from a licensed physician indicating PRC License No. Valid NBI Clearance One passport size picture

2 INFORMATION SHEET I. PERSONAL INFORMATION a. b. c. d. e. f. g. Last Name First Name Middle Name Permanent Address: No. Street City/Municipality Province Zip Code Region District Passport No. address Current Mailing Address Telephone Nos. (Landline/Mobile) Civil Status Date of Birth Age Sex Name of Parents (Father) (Mother) Address II. GRADUATE SCHOLARSHIP INTENTIONS DATA New Applicant a. University where you applied/intend to enrol for graduate studies b. Course/Degree Lateral Applicant a. University Enrolled in b. Course/Degree c. Number of units d. GWA e. No. of remaining sems earned III. CAREER/EMPLOYMENT INFORMATION a. Present Employment Status: ( ) Permanent ( ) Contractual ( ) Probationary ( ) Self-employed ( ) Unemployed

3 a.1 For those who are presently employed Position Length of Service Name of Company/Office Address of Company/Office Telephone No. Website Fax No. a.2 For those who are self-employed Business Name Address /Website Tel. No. Type of Business Years of Operation * Once accepted into the scholarship program, the scholar must obtain permission to take a leave of absence from his/her employer and become a full time student. The scholar must submit a letter/ certification from his/her employer agreeing to the leave. b. CAREER PLANS (Write in a separate paper) b1. A narrative, not more than 1000 words, describing your current work or a project (or research) that you worked on and your contribution towards the completion of the project. b2. Future Plans (After Graduation) b3. For PhD applicants, a narrative describing your intended research area IV. RESEARCH AND DEVELOPMENT INVOLVEMENT (last five years) Use additional sheet if necessary. FIELD AND TITLE OF RESEARCH LOCATION/DURATION FUND SOURCE NATURE OF INVOLVEMENT

4 V. PUBLICATIONS (last five years) Use additional sheet if necessary. TITLE OF ARTICLE/PUBLICATION PLACE/YEAR OF PUBLICATION NATURE OF INVOLVEMENT VI. 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

5 LETTER OF RECOMMENDATION FOR ADMISSION TO ERDT SCHOLARSHIP PROGRAM To be completed by applicant (Please type or Print) Name: Current Address: Degree program applied for: Start of graduate study: 1 st semester 2 nd semester AY - Note to applicant: Ask your recommender to enclose this form in an envelope, seal the envelope, and sign across the seal. Submit the envelop with its seal unbroken with the rest of your application materials to the ERDT office, Rm. 309 SEC A Building, Office of the Dean, School of Science and Engineering, Ateneo de Manila University, Loyola Heights, Quezon City To be completed by recommender Any pertinent information regarding the applicant and your evaluation of the applicant s ability to undertake graduate studies and research will be held in strict confidence. How long have you known the applicant? In what capacity have you known the applicant? If the applicant was a student in some of your classes, what were these subjects? What do you consider as the applicant s outstanding talents or strengths in relation to graduate study? What do you consider as his/her weakness or deficiencies in relation to graduate study

6 Please rate the applicant on the following characteristics in comparison with other students in the same disciplines who are known to you and who have had more or less the same amount of training and experience. (Indicate size of group with which applicant is being compared and its educational level ). 1. Intellectual ability 2. Academic preparation for proposed field of study 3. Motivation for proposed field of study 4. Originally, creativity & imagination 5. Analytical & problem-solving ability 6. Initiative and independence 7. Honesty & integrity 8. Conscientiousness & ability to work independently 9. Ability to work with others 10. Oral communication skills 11. Written communication skills 12. Emotional maturity 13. Potential as a researcher in the discipline 14. Potential as a teacher in the discipline Excellent Above Average Average Below Average Inadequate basis for judgment Additional information and comments about the applicants (please use a separate sheet of paper, if necessary). I therefore strongly recommend recommend recommend with reservations do not recommend the applicant for admission to graduate studies in your college. Recommender s Printed Name: Recommender s Signature: Date: Position: Highest Educational Attainment: Name and Address of Organization: *Note to recommender: Please enclose this form in an envelope, seal the envelope, sign across the seal, and return sealed envelope to applicant.