Rev.

7/03-28-2023
*THE CONSORTIUM PROHIBITS THE
FILING OF MULTIPLE APPLICATIONS.

**THOSE WHO WERE GRANTEES OF

THE DOST-SEI JLSS-RA 10612
PROGRAM ARE NOT ALLOWED TO ENGINEERING RESEARCH AND DEVELOPMENT FOR
APPLY UNLESS HAVE COMPLETED
THE RETURN SERVICE.
TECHNOLOGY (ERDT) SCHOLARSHIP PROGRAM

APPLICATION FORM Attach here

1 latest passport
size picture
Academic Year _________________
School Term: [ ] First [ ] Second [ ] Third Semester/Term

TYPE OF SCHOLARSHIP APPLIED FOR:

MS Ph.D. BS-MS Straight Program M.Eng. Straight Ph.D.
TYPE OF ENTRY:
NEW LATERAL (with graduate units earned)
GENERAL INSTRUCTIONS:
• Please fill-out the form legibly and completely.
• Kindly write in BLOCK LETTERS
• Do not leave any blank fields (State N/A if not applicable to you).
• Have a scanned copy of the complete set of documents in ONE PDF file only with the filename following the format: Lastname_Firstname.pdf.
Ensure that the accomplished application form and other documents are readable, properly scanned and that the files are not corrupted.
___________________________________________________________________________________________________________________________________
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 on a full-time basis for a minimum period 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; and
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)
 Birth Certificate (photocopy)
 Certified True Copy of the Official Transcript of Records (TOR)
 Recommendation letters from 3 past professors/supervisors (see attached sheet)
 Narrative essays (see page 3)
 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
 Letter of Admission with Regular status from the Program Head of the accepting institution; include the evaluation sheet
 Approved Program of Study
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
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
_______________________________________________________________________
I. PERSONAL INFORMATION
a.
Last Name First Name Middle Name Suffix (Jr. , II)
b.
Complete Permanent Address
c.
Zip Code Region District E-Mail Address
d.
Current Mailing Address (if different from the permanent address)
e.
Telephone Nos. (Landline/Mobile)
f.
Civil Status Date of Birth (mm/dd/yyyy) Age Sex
1
g.
Father’s Name Mother’s Name
h. Emergency Contact Person:
Complete Name
Complete Address
Relationship
Contact Number

II. ACADEMIC BACKGROUND

PERIOD
SCHOLARSHIP
LEVEL Year Year FIELD UNIVERSITY/SCHOOL REMARKS
(if applicable)
Started Ended
 PSHS
HS
 OTHERS: _________
 RA 7687
 NSDB/NSTA/MERIT
BS
 RA 10612**
 OTHERS: _________
 NSDB/NSTA
 ASTHRDP
 CBPSME
 ERDT
MS
 STRAND
 FGS
 DOST COUNCIL/SEI
 OTHERS: _________
 NSDB/NSTA
 ASTHRDP
 CBPSME
 ERDT
PHD
 STRAND
 FGS
 DOST COUNCIL/SEI
OTHERS: _________

III. GRADUATE SCHOLARSHIP INTENTIONS DATA

(Note: An applicant for a graduate program may elect to go to another university if he/she earned his/her 1st (BS) and/or 2nd (MS) degrees from the
same university to avoid inbreeding.)
New Applicant
University where you applied/ intend
a.
to enroll for graduate studies
b. Course/Degree

c. Did you apply to other consortium member-universities? *  YES  NO

Lateral Applicant
a. University enrolled in
b. Course/Degree
c. Total no. of units required in the program d. No. of units earned e. No. of remaining units
f. Has your MS/Ph.D. research topic been approved by the panel?  YES  NO
g. Date of last enrolment in thesis/dissertation course
h. Other scholarship program applied for (please specify)

IV. CAREER/EMPLOYMENT INFORMATION

a. Present Employment Status Permanent Contractual Probationary Self-employed Unemployed
a.1 For those who are presently employed***
Position
Length of Service From: (MM-DD-YYYY) Until: (MM-DD-YYYY)
Name of Company/Office
Address of Company/Office
Email Website
Telephone No. Fax No.

***Once accepted in the scholarship program, the scholar must obtain permission to take a Leave of Absence (LOA) from his/her employer
and become a full-time student. The scholar must submit proof of the employer’s approval of the LOA.
2
 Employment History
Period (MM/YYYY) Full-Time (F) or
Name of Employer Title/Position
From To Part-Time (P)

a.2 For those who are self-employed

Business Name
Address
Email Website
Telephone No. Fax No.
Type of Business Years of Operation

V. POST-GRADUATE STUDIES
Enrollment (MM/YYYY)
Name of Institution Location Degree Received
From Until

VI. SCHOLASTIC HONORS & AWARDS RECEIVED

Title of Award Award Giving Body Date Received

VII. RECENT SCIENTIFIC PUBLICATIONS (DONE WITHIN THE LAST FIVE YEARS)

Title of Paper Title of Publication Date Published

VIII. RECENT SCIENTIFIC CONFERENCE PRESENTATIONS (DONE WITHIN THE LAST FIVE YEARS)

Title of Paper Name of Conference Date Presented

IX. OTHER QUALIFICATIONS (MEMBERSHIP TO PROFESSIONAL ORGANIZATIONS, ELIGIBILITIES, PROFESSIONAL LICENSE, ETC.)

X. RESEARCH & CAREER PLANS

Write on a separate paper (minimum of 300 words and maximum of 1000 words for essay 1 & 2) the following:
A description of the current work or project or undergraduate research that have been done (for those who have just graduated from
Essay 1
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.

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
Essay 3
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.
XI. REFERENCES

Name Company of Affiliation & Address Contact Number/s

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XII. TRUTHFULNESS OF DATA AND DATA PRIVACY

I hereby certify that all information given above are true and correct to the best of my knowledge. Any misinformation or withholding of
information will automatically disqualify me from the program, Engineering Research and Development for Technology (ERDT). I am willing to refund
all the financial benefits received plus appropriate interest if such misinformation is discovered.

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 indemnified in case of damages pursuant to the provisions of the Republic Act No. 10173 of the Philippines, Data Privacy Act of 2012 and
its corresponding Implementing Rules and Regulations.

Printed Name and Signature of Applicant

Date: _____________________

XIII. ERDT SCHOLARSHIP SURVEY

How did you know about the ERDT scholarship?

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

4
 LETTER OF RECOMMENDATION
ENGINEERING RESEARCH AND DEVELOPMENT FOR TECHNOLOGY (ERDT) SCHOLARSHIP

APPLICANT’S INFORMATION To be filled out by the applicant

Last Name
Given Name
Middle Name Maiden Name for married female applicants

Degree Applied For

Note to the Applicant: Ask the recommender to enclose this form in a sealed envelope, with his/her signature written across the
seal. The envelope must be submitted with its seal unbroken together with the rest of your application materials to the ERDT
Office.

APPLICANT’S EVALUATION To be filled out by the recommender

Note to the 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?

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 the group with which applicant
is being compared and its educational level.

Group Size Educational Level

 Above Below
Excellent Average No Basis
Average Average

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

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 the scholarship program.

Signature over Printed Name Date

RECOMMENDER’S INFORMATION
Title Engr./Dr./Prof.
Given Name Middle Initial
Last Name
Affiliated Organization
Position in Organization
Address of Organization
Highest Educational Attainment
 ENGINEERING RESEARCH AND DEVELOPMENT FOR
TECHNOLOGY (ERDT) SCHOLARSHIP PROGRAM

MEDICAL CERTIFICATE

___________________
Date

TO WHOM IT MAY CONCERN:

This is to certify that I have examined ______ __________________ _____ and found
(Name of Applicant)
him/her to be physically and mentally fit to undergo graduate studies.

This certification is issued in connection with his/her application for scholarship under
master’s/doctoral program of the Engineering Research and Development for Technology
(ERDT).

_____________________________ ______________________________________
Health Agency Name (Print) and Signature of Licensed
Physician

_____________________________ __________________________
Address PRC License No.