Rev.

6/03-28-2022
*THOSE WHO WERE GRANTEES
OF THE DOST-SEI JLSS-RA 10612
PROGRAM ARE NOT ALLOWED
TO APPLY UNLESS HAVE ENGINEERING RESEARCH AND DEVELOPMENT FOR
COMPLETED THE RETURN Attach here 1 latest
SERVICE. TECHNOLOGY (ERDT) SCHOLARSHIP PROGRAM
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APPLICATION FORM

TYPE OF SCHOLARSHIP APPLIED FOR:

NEW LATERAL

MS BS-MS MEng PhD Straight PhD

Straight Program

LAST NAME GIVEN NAME MIDDLE / MAIDEN NAME

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 50 years of age at the time of application
3. Must have a BS degree in engineering or related field (for MS applicants)
4. Must have an MS degree in engineering or related field (for PhD applicants)
5. Must be in good health as attested by medical certificate
6. Must not have criminal/administrative cases
7. Must be enrolled as a full-time graduate student
8. Must not have other scholarship contract that will interfere with the terms and conditions of the ERDT Scholarship
Agreement
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.
_ _ _ _ _ _ _ __ _ _ _ _ _ _ ___ _ _ _ _ _ __ _ _ _ _ _ _ __ _ _ _ _ _ _ __ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
CHECKLIST OF REQUIRED DOCUMENTS (for staff use only)

 Narrative essays (see page 4)

 Recommendation letter from 3 past professors/supervisors (see attached sheet)
 Certified True Copy of Grades (TCG)/Transcript of Records (TOR)
If employed:
 Permission to take a Leave of Absence (LOA) while on scholarship or Proof of resignation or
termination of contract.
 Certificate of No Pending Administrative Case
 Birth Certificate (photocopy)
 Medical Certificate stating that the applicant is physically and mentally fit to study from a licensed
physician with his/her PRC license number indicated (see attached medical cert. form)
 Valid NBI Clearance
 Acceptance Letter/Notice of Admission from the Graduate School
 Approved Program of Study
Additional Requirements for Lateral Applicants:
 Certification from the university indicating the following:
• number of graduate units required in the program
• number of graduate units already earned with corresponding grades

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I. GRADUATE SCHOLARSHIP INTENTIONS DATA
1.a University where you intend to enroll for graduate studies: _____________________________________________________________

1.b. Intended start of program of study: ( ) First Semester ( ) Second Semester AY _________ - __________

1.c. Are you applying for another scholarship grant? ( ) YES ( ) NO

If yes, kindly specify the name of the scholarship program: _______________________________________________

1.d. For Lateral Applicant:

1.d.1. When did you start your graduate study? ( ) First Semester ( ) Second Semester AY _________ - _________

1.d.2. Total number of units required in the program: ___ Number of units earned: ___ GWA: ___ Number of remaining units: ___

II. PERSONAL INFORMATION Kindly write in BLOCK LETTERS

2.a. Last Name Male Female Age
Given Name Birth Date (MM/DD/YY)

Middle Name Birth Place

Maiden Name for married female applicants Civil Status
Country of Origin Citizenship

2.b. Complete Current Address

No P.O. Box Street, Village, Town, Province

Zip Code Region Country

Complete Permanent Address

Street, Village, Town, Province

Zip Code Region Country

2.c. Contact Number/s

E-mail Address

2.d. Father’s Name

Mother’s Name Write the Maiden NAME.

2.e. Emergency Contact Person

Complete Name
Complete Address
Relationship
Contact Number

III. EMPLOYMENT INFORMATION

3.a. Current Employment Status Self-Employed Employed Full-Time Employed Part-Time Unemployed
3.b. Currently Employed Applicants (Full-Time/Part-Time)
Position Length of Service
Telephone
Company Name
Number/s
Office Address
E-mail Address Company Website

3.c. Self-Employed Applicants

Business Name
Business Address
E-mail/Website Telephone Number
Type of Business Years of Operation
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3.d. Employment History

Period (MM/YYYY) Full-Time (F) or

Name of Employer Title/Position
From To Part-Time (P)

IV. ACADEMIC BACKGROUND

4.a. SECONDARY EDUCATION
Last High School Attended Date Started /
School Name Date Graduated /
School Address

4.b. TERTIARY EDUCATION

Enrollment (MM/YYYY)
Name of University/School Location Degree Received
From Until

DOST-SEI SCHOLARSHIPPROGRAM INFORMATION:

If you have previously availed of any of the DOST-SEI scholarship program, please indicate below (put a check):
Scholarship Program Year of Award/Graduated Course /School

_____ Merit _______________________ ________________________________________________________

_____ RA 7687 _______________________ ________________________________________________________

_____ RA 10612 _______________________ ____________________________________________++__________

_____ ERDT _______________________

_____ Others _______________________

4.c. POST-GRADUATE STUDIES

Enrollment (MM/YYYY)
Name of Institution Location Degree Received
From Until

4.d. SCHOLASTIC HONORS & AWARDS RECEIVED

Title Awarding Institution Date Received

4.e. RECENT SCIENTIFIC PUBLICATIONS (DONE WITHIN THE LAST FIVE YEARS)
Title of Paper Title of Publication Date Published

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4.f. RECENT SCIENTIFIC CONFERENCE PRESENTATIONS (DONE WITHIN THE LAST FIVE YEARS)
Title of Paper Name of Conference Date Presented

4.g. OTHER QUALIFICATIONS (MEMBERSHIP TO PROFESSIONAL ORGANIZATIONS, ELIGIBILITIES/CERTIFICATES, PROFESSIONAL LICENSE, ETC)

V. RESEARCH & CAREER PLANS

Write on a separate paper (minimum of 300 words and maximum of 1000 words for essay 1 & 2) the following:
Essay 1 A description of the current work or project or undergraduate research that have been done (for those who have just
graduated from BS degree) or graduate research that have been done (for those applying for the doctoral program).
Essay 2 Future plans after graduation from the applied graduate program.
Essay 3 Intended research work to be done while in the graduate program. This research proposal should include the following
components: problem statement, significance of the research, brief literature review, outlined methodology, and Gantt
chart. Note that Year 1 is usually devoted to doing course work; make a research timeline for one (1) year for the
master’s degree and two (2) years for doctoral degree of study.

VI. REFERENCES
Name Company of Affiliation & Address Contact Number/s

VII. APPLICANT’S DECLARATION

I declare that the information supplied in this application and the documentation supporting it are true and complete. I
acknowledge that the provision of incorrect information or documentation relating to my application may result in
cancellation of admission or enrolment. If admitted, I solemnly agree to abide by the rules and regulations of ERDT
Scholarship Program, the College of Engineering and the University. Moreover,

I hereby authorize the Science Education Institute of the Department of Science and Technology (SEI-DOST) to collect,
record, organize, update or modify, retrieve, consult, use consolidate, block, erase, or destruct my personal data that I
have provided in relation to my application to this scholarship. I hereby affirm my right to be informed, object to
processing, access and rectify, suspend, or withdraw my personal data, and be identified in case of damages pursuant
of the Republic Act No. 10173 of the Philippines, Data PrivacyAct of 2012 and its corresponding Implementing Rules
and Regulations.

Signature Over Printed Name Date

VIII. ERDT Scholarship Survey

How did you know about the ERDT scholarship?

University/campus roadshow
Website
ERDT scholar
Others (please specify)