Document Code: OETEEAP-F_AF

Document Title: Page No: 1 of 9

MANUEL S. ENVERGA UNIVERSITY FOUNDATION ETEEAP Application
Form
An Autonomous University Revision No.: 2
LUCENA CITY Effectivity Date: December 2017
Prepared by: ETEEAP Center
Reviewed by: QMR
Department: EXPANDED TERTIARY EDUCATION EQUIVALENCY Approved by: President
ACCREDITATION PROGRAM (ETEEAP) CENTER

ETEEAP APPLICATION FORM

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Picture ID

INSTRUCTIONS: Please type or clearly print your answers to all questions. Provide
complete and detailed information required by the questionnaire. All the
declarations that you make are under oath. Discovery of any false claim in this
application form will disqualify you from participating in the program.

I. PERSONAL INFORMATION

1. NAME (Last Name, First Name, Middle Name)

____________________, _______________________, ____________________
2. Address : ________________________________________________________
Zip Code : _______________
3. Telephone No(s). : _____________________________
4. Birth Date : _________________________
5. Birthplace : _________________________
6. Civil Status : ________________________
7. Sex : ___________ Nationality : ____________________
8. Languages and Dialects Spoken : _________________________________

9. Degree Program or field being applied for :

First Priority : ____________________________________________

Second Priority : ____________________________________________
Third Priority : ____________________________________________

10. Statement of your goals, objectives or purposes in applying for the

degree.
___________________________________________________________________________
___________________________________________________________________________
________________________________________________

11. Indicate how much time you plan to devote for personal learning activities
so that you can finish the requirements in the prescribed program. Be
specific.
___________________________________________________________________________
___________________________________________________________________________
________________________________________________

12. For overseas applicants, describe how you plan to obtain

accreditation/equivalency. (e.g. when you plan to come to the Philippines)
___________________________________________________________________________
___________________________________________________________________________
________________________________________________
 Document Code: OETEEAP-F_AF
Document Title: Page No: 2 of 9
MANUEL S. ENVERGA UNIVERSITY FOUNDATION ETEEAP Application
Form
An Autonomous University Revision No.: 2
LUCENA CITY Effectivity Date: December 2017
Prepared by: ETEEAP Center
Reviewed by: QMR
Department: EXPANDED TERTIARY EDUCATION EQUIVALENCY Approved by: President
ACCREDITATION PROGRAM (ETEEAP) CENTER

How soon do you need to complete equivalency/accreditation?

_____ less than one (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 learning experiences.

1. Formal Education

Course/Degree Name of Inclusive Dates

Program School/Address of Attendance

Note : All entries should be supported by authenticated photocopy of

appropriate certificates/documents obtained from the institution
through the program.

2. 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 Training Title of Certificate Inclusive Dates

Program Obtained of Attendance

Note : All entries should be supported by authenticated photocopy of

appropriate certificates/documents obtained from the institution
through the program.

3. Other Certification Examinations

Please give detailed information on certification examinations taken for

vocational and other skills.

Title of
Name/Address of Date
Certification Rating
Certifying Agency Certified
Examination

Note : All entries should be supported by authenticated photocopy of

appropriate certificates/documents obtained from the institution
through the program.
 Document Code: OETEEAP-F_AF
Document Title: Page No: 3 of 9
MANUEL S. ENVERGA UNIVERSITY FOUNDATION ETEEAP Application
Form
An Autonomous University Revision No.: 2
LUCENA CITY Effectivity Date: December 2017
Prepared by: ETEEAP Center
Reviewed by: QMR
Department: EXPANDED TERTIARY EDUCATION EQUIVALENCY Approved by: President
ACCREDITATION PROGRAM (ETEEAP) CENTER

III. PAID WORK AND OTHER EXPERIENCES

1. Post/Designation
_____________________________________________

2. Inclusive Dates of Employment

From : __________________ to __________________

3. Name and Address of Company

__________________________________________________
__________________________________________________

4. Terms/Status of Employment
______________________________

5. Name and Designation of Immediate Supervisor

_______________________________________________
_______________________________________________

6. Reason(s) for moving on to the next job.

_________________________________________________________________
_________________________________________________________________
_________________________________________________________________

7. Describe actual functions and responsibilities in position occupied:

___________________________________________________________________________
___________________________________________________________________________
________________________________________________

8. In case of self-employment, name three (3) reference persons; including

their current addresses and contact numbers.
_________________________________________________
_________________________________________________
_________________________________________________

Note : 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 for work
excellence, outstanding accomplishments, community service, etc.

1. Academic Award

Name and Address of Date

Award Conferred
Conferring Organization Awarded
 Document Code: OETEEAP-F_AF
Document Title: Page No: 4 of 9
MANUEL S. ENVERGA UNIVERSITY FOUNDATION ETEEAP Application
Form
An Autonomous University Revision No.: 2
LUCENA CITY Effectivity Date: December 2017
Prepared by: ETEEAP Center
Reviewed by: QMR
Department: EXPANDED TERTIARY EDUCATION EQUIVALENCY Approved by: President
ACCREDITATION PROGRAM (ETEEAP) CENTER

2. Community and Civic Organization Award/Citation

Name and Address of Date

Award Conferred
Conferring Organization Awarded

3. Work Related Award/Citation

Name and Address of Date

Award Conferred
Conferring Organization Awarded

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 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.

1. Description : _____________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
_______________________________________
2. Date Accomplished : ________________________
3. Name and Address of Publishing Agency (if written, published work), or an
Association/Institution which can attest to the quality of the work.
______________________________________________________
___________________________________________________________________________
_________________________________________________________

Note : Use additional sheet if necessary, following the same format.

VI. LIFELONG LEARNING EXPERIENCE

 Document Code: OETEEAP-F_AF
Document Title: Page No: 5 of 9
MANUEL S. ENVERGA UNIVERSITY FOUNDATION ETEEAP Application
Form
An Autonomous University Revision No.: 2
LUCENA CITY Effectivity Date: December 2017
Prepared by: ETEEAP Center
Reviewed by: QMR
Department: EXPANDED TERTIARY EDUCATION EQUIVALENCY Approved by: President
ACCREDITATION PROGRAM (ETEEAP) CENTER

In this section, please indicate the various life experiences from which you
must have derived some learning experience. Please include here unpaid
volunteer work.

1. Hobbies/Leisure Activities

Leisure activities which involve rating of skills for competition and other
purposes (e.g. “belt concept in tae-kwon-do) may also indicate your level
for ease of evaluation. On the other hand, watching Negosiyete on a
regular basis can be considered a learning opportunity.

___________________________________________________________________________
___________________________________________________________________________
________________________________________________

2. Special Skills

Note down those special skills which you think must be related to the field
of study you want to pursue.

___________________________________________________________________________
___________________________________________________________________________
________________________________________________

3. Work-Related Activities

Some work-related activities are occasions for you to learn something

new. For example, being assigned to projects beyond your usual job
description where you learned new skills and knowledge. Please do not
include formal training programs you already cited. However, you may
include here experiences which can be classified as on-the-job training or
apprenticeship.
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
_______________________________________

4. Volunteer Activities

List only volunteer activities that demonstrate learning opportunities, and

are related to the course you are applying for credit. (e.g. counseling
programs, sports coaching, project organizing or coordination,
organizational leadership, and the like)
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
_______________________________________

5. Travels : Cite places visited and purpose of travel

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.
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
 Document Code: OETEEAP-F_AF
Document Title: Page No: 6 of 9
MANUEL S. ENVERGA UNIVERSITY FOUNDATION ETEEAP Application
Form
An Autonomous University Revision No.: 2
LUCENA CITY Effectivity Date: December 2017
Prepared by: ETEEAP Center
Reviewed by: QMR
Department: EXPANDED TERTIARY EDUCATION EQUIVALENCY Approved by: President
ACCREDITATION PROGRAM (ETEEAP) CENTER

___________________________________________________________________________
______________________________
VII. To sum up, please write an essay on how your attaining a degree contribute
to your personal development, your community, your workplace, society, and
country?
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

I declare under oath that, the foregoing claims and information I have
disclosed are true and correct. Done in ________________________________, on this
______ day of ________________________.

Signed :

____________________________________________
Printed Name and Signature of Applicant

Community Tax Certificate ________________________

Issued on _____________________________ at ____________________________
 Document Code: OETEEAP-F_AF
Document Title: Page No: 7 of 9
MANUEL S. ENVERGA UNIVERSITY FOUNDATION ETEEAP Application
Form
An Autonomous University Revision No.: 2
LUCENA CITY Effectivity Date: December 2017
Prepared by: ETEEAP Center
Reviewed by: QMR
Department: EXPANDED TERTIARY EDUCATION EQUIVALENCY Approved by: President
ACCREDITATION PROGRAM (ETEEAP) CENTER

What is the ETEEAP?

The Expanded Tertiary Education Equivalency and Accreditation Program

(ETEEAP) is a comprehensive program of identifying, assessing, validating and
assigning equivalent undergraduate level of prior learning from formal, non-formal
and informal training and relevant work experiences and completion of competency
enrichment and other program requirements toward the final granting of
appropriate undergraduate academic degrees.

By establishing equivalency competence standards and a comprehensive

assessment system employing written test, interview, skills demonstration and
other creative assessment methodologies, higher education institutions may
administer competency-based evaluation. A Panel of Assessors is convened to
determine the candidates’ knowledge, skills and attitudes relevant to a particular
discipline, and consequently equivalent credits and appropriate certificates and
degrees are awarded by deputized higher education institutions.

The mandate to implement the program is embodied in Executive Order 330

issued by President Fidel V. Ramos on May 13, 1996 as an offshoot of the
recommendation of the First Employment Summit in September 1995.

1. Qualification of the Individual Applying for Equivalency and

Accreditation.

1.1.Completion of secondary school program as evidenced by a high school

diploma, or the PEPT/ALS A & E result stating “qualified to enter first year
college”;

1.2.Employment for an aggregate of at least five (5) years in the industry related
to the academic degree program or discipline where equivalency of learning
is sought; and

1.3.A Filipino citizen and at least twenty-five (25) years old as supported by an
NSO authenticated birth certificate.

2. Application for Grant of Second Degree through ETEEAP.

A bachelor’s degree holder may apply for equivalency and accreditation of prior
and work-based learning towards the grant of up to the second degree only;
provided however, that such sources of learning are related to the second degree
being sought under ETEEAP.

3. Procedure for Application and Assessment of Learning.

3.1.The individual applicant secures the application form from any deputized
HEI, or downloads the form from the CHED website, www.ched.gov.ph,
establishes his/her qualifications for the program, and pays appropriate
application fees to a deputized HEI of his/her choice.

3.2.The accepting HEI reviews the application, interviews the applicant and
informs him/her in writing of the results of the review and interview.

3.3.Upon approval of the application, the deputized HEI requires the applicant
(candidate) to prepare and submit his/her portfolio with the assistance of the
institution’s career counselor/adviser within an agreed period of time. This
portfolio should include descriptions of prior experiences in the context of
learning outcomes. The employer concerned should certify all experiences
cited by the candidate as having been completed whole in employment.
 Document Code: OETEEAP-F_AF
Document Title: Page No: 8 of 9
MANUEL S. ENVERGA UNIVERSITY FOUNDATION ETEEAP Application
Form
An Autonomous University Revision No.: 2
LUCENA CITY Effectivity Date: December 2017
Prepared by: ETEEAP Center
Reviewed by: QMR
Department: EXPANDED TERTIARY EDUCATION EQUIVALENCY Approved by: President
ACCREDITATION PROGRAM (ETEEAP) CENTER

3.4.Upon receipt of the portfolio, the HEI convenes a panel of assessors to

conduct the evaluation. Tests or other forms and instruments of
assessments, e.g. interviews, actual demonstration of claimed knowledge
and skills, written examination, and others that are appropriate to the
candidate’s needs may be used as needed.

3.5.After completing the evaluation, the panel of assessors determines the

amount of equivalent credit that will be awarded to the candidate by
matching the demonstrated training and learning from prior work
experiences of the candidate with the learning outcomes and standards of
the subject or course for which the candidate seeks accreditation and
equivalency. A rubric or a similar tool shall be developed for the purpose.

3.6.A candidate assessed to be deficient in one or more competency units will be

required to pursue further learning, with the assistance of a career
coordinator or adviser. In this case, a learning contract that defines the
learning program is executed between the deputized HEI and the candidate.
Further, assessment is conducted after the completion of the learning
program to determine the learning progress of the candidate toward
meeting the learning outcomes and standards specified in the said program.

3.7.The accomplished rubric or any situation or any similar instrument that

documents the learning of the candidates from prior work experiences
should be maintained as a permanent official record in the ETEEAP Office of
the institution.

3.8.After satisfying all the learning outcomes and appropriate assessment

criteria for the course, and having complied with the requirements
prescribed by CHED and the institution for completion of the course, the
candidate is awarded the appropriate equivalency credit for an academic
degree.

3.9.Graduates of the ETEEAP programs are qualified to take the appropriate

licensure examinations, unless otherwise provided by law.
 Document Code: OETEEAP-F_AF
Document Title: Page No: 9 of 9
MANUEL S. ENVERGA UNIVERSITY FOUNDATION ETEEAP Application
Form
An Autonomous University Revision No.: 2
LUCENA CITY Effectivity Date: December 2017
Prepared by: ETEEAP Center
Reviewed by: QMR
Department: EXPANDED TERTIARY EDUCATION EQUIVALENCY Approved by: President
ACCREDITATION PROGRAM (ETEEAP) CENTER