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    RDMD TCDS F1 - Rev1 - 8 23 12 - AssMem PDF

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    Juvyneil Cartel
    This document is an application form for associate membership in the National Research Council of the Philippines. It requests information such as the applicant's name, date of birth, education history, fields of specialization, positions held, research experience, publications, and division/section preferences. The form must be signed by the applicant and have two passport photos attached.

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    RDMD TCDS F1 - Rev1 - 8 23 12 - AssMem PDF

    Uploaded by

    Juvyneil Cartel
    252 views3 pages
    This document is an application form for associate membership in the National Research Council of the Philippines. It requests information such as the applicant's name, date of birth, education history, fields of specialization, positions held, research experience, publications, and division/section preferences. The form must be signed by the applicant and have two passport photos attached.

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    RDMD-TCDS-F1_rev1_8-23-12_AssMem.pdf

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    This document is an application form for associate membership in the National Research Council of the Philippines. It requests information such as the applicant's name, date of birth, education history, fields of specialization, positions held, research experience, publications, and division/section preferences. The form must be signed by the applicant and have two passport photos attached.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    252 views3 pages

    RDMD TCDS F1 - Rev1 - 8 23 12 - AssMem PDF

    Uploaded by

    Juvyneil Cartel
    This document is an application form for associate membership in the National Research Council of the Philippines. It requests information such as the applicant's name, date of birth, education history, fields of specialization, positions held, research experience, publications, and division/section preferences. The form must be signed by the applicant and have two passport photos attached.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 3

    RDMD-TCDS F1

    Rev. 1/08-23-12

    (ASSOCIATE MEMBERSHIP)
    Republic of the Philippines
    Department of Science and Technology
    NATIONAL RESEARCH COUNCIL OF THE PHILIPPINES Please attach 2
    (Pambansang Sanggunian sa Pananaliksik ng Pilipinas) copies of
    General Santos Avenue, Bicutan, Tagig, Metro Manila Passport size ID
    Tel. No. 837-0409; 837-6141 to 43; Telefax: 839-0275 picture
    Email: [email protected]; [email protected]

    ___________________
    (Date)
    1. Name
    Surname First Name Middle Name

    2. Date of Birth: Place of Birth


    3. Civil Status: Sex:
    4. Present Position: Citizenship:
    Official Address:
    Tel No. E-mail: Fax No.
    5. Residence Address:
    Tel No.
    6. If married, give full name of wife/husband:
    Children:

    7. Educational Background:
    Degree Received Institution Year
    (Bachelor)
    (Master’s)
    (Doctoral)
    (Post Graduate)
    7.a Title of Master’sThesis:

    7.b Title of Doctoral Dissertation:

    8. Field of Specialization (at most two (2) specializations):


    9. Division and Section Preference (see Annex “A”)
    10. Position(s) held: (please continue on separate sheet if necessary)

    11. Academic honors, research fellowship, award(s) received:

    12. Membership in learned societies of professional organizations (indicate if officer at present)


    13. International/national congresses/symposia attended of participated:

    14. Who’s Who Publication where name is included, please state the details (title, publisher,
    edition, and year and place of publication):

    15. Consultancy Services:

    16. Research and development or design/creative works, giving complete details; (title of
    research, funding, agency, inclusive years, position in research and names of co-workers).
    Please submit: 1.) certification of research undertaking/s for the past three (3) years
    from the head of agency or immediate supervisor where you are connected;
    2.) abstract of completed research or objectives, accomplishments and/or progress
    report of on-going projects being certified.

    17. List of published scientific or technical articles, or reports of completed professional or


    documented original design/creative works (complete with bibliographical details).
    Continue on separate sheet if necessary (applicable for applicants under Criterion A).
    Submit copies of at least two (2) published scientific or technical articles, or reports of
    completed professional or documented original design/creative works within the last five (5)
    years.

    I hereby certify that all information previously stated is true and correct.

    ________________________
    (Signature)
    NRCP DIVISIONS/SECTIONS PREFERENCE “Annex A”
    Division I - Governmental, Educational and International Policies
    Section of Educational Policies
    Section of Governmental Policies
    Section of International Policies

    Division II - Mathematical Sciences


    Section of Statistics & Computer Science
    Section of Actuarial Science
    Section of Mathematics & Operations Research

    Division III - Medical Sciences


    Section of Basic Science
    Section of Clinical Medicine
    Section of Public Health
    Section of Medical Education

    Division IV - Pharmaceutical Sciences


    Section of Pharmaceutical Chemistry
    Section of Pharmacy
    Section of Pharmacopoeia
    Section of Pharmaceutics

    Division V - Biological Sciences


    Section of Plant Science
    Section of Animal Science
    Section of Microbiology
    Section of Nutrition
    Section of Aquatic Biology

    Division VI - Agriculture & Forestry


    Section of Crops and Soils
    Section of Animal Production
    Section of Forest Production
    Section of Forest Utilization
    Section of Socio- Economics & Rural Studies

    Division VII - Engineering and Industrial Research


    Section of Materials & Structures
    Section of Eng’g. Processes & Systems
    Section of Energy
    Section of Environmental Technology
    Section of Information Communication Technology
    Section of Transportation
    Section of Water Resources Management
    Section of Industrial Quality & Standard

    Division VIII - Social Sciences


    Section of Anthropology and Linguistics
    Section of Sociology, Social Work & Demography
    Section of Political Science & Public Administration
    Section of Psychology & Philosophy
    Section of Economics and Business Administration
    Section of Geography & History
    Section of Education & Communication

    Division IX - Physics

    Division X - Chemical Sciences


    Section of Inorganic, Physical & Analytical Chemistry
    Section of Organic & Biological Chemistry
    Section of Environmental Science & Industrial Chemistry

    Division XI - Humanities
    Section of Language
    Section of Literature
    Section of Visual Arts
    Section of Performing Arts

    Division XII – Earth and Space Sciences


    Section of Meteorology and Oceanography
    Section of Geology and Seismology
    Section of Astronomy and Space Science

    Division XIII – Veterinary Medicine

    √Please tick off the division/section preference of your choice.

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