Eteeap Application Form Pangasinan State U

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ETEEAP Form No.

1
Application Form

Republic of the Philippines


PANGASINAN STATE UNIVERSITY
EXPANDED TERTIARY EDUCATION EQUIVALENCY
AND ACCREDITATION PROGRAM (ETEEAP)
Lingayen, Pangasinan

APPLICATION FORM FOR ADMISSION IN THE PROGRAM

I. Personal Data/Applicant’s Profile:

1. Name:_______________________________________________________________
Family Name Given Name Middle Name

2. Birthdate:_______________________ 3. Civil Status: ________________________


4. Home Address:________________________________________________________
5. Res. Telephone No.:____________________ 6. Mobile Phone No.:_______________
7. Educational Qualification:
Degree Earned College(Name of School) Year Graduated
_______________________ _____________________ _____________________
_______________________ _____________________ _____________________
_______________________ _____________________ _____________________

8. Academic Honors Received:_____________________________________________


Reasons in Applying for Admission in the PSU ETEEAP:______________________
______________________________________________________________________
______________________________________________________________________

II. Present Work Information:


9. Agency Working With:__________________________________________________
10. Address of Agency:___________________________________________________
11. Telephone Number:__________________ 12. Present Position:________________
13. Nature of Appointment:________________ 14. No. Of years in Service:_______
15. Salary:_____________

____________________ ________________________
Date Applicant’s Signature

III. Admission Requirements (To be filled in by Interviewer)

Date of Interview:____________ Rating:_______________

Action Taken:
Accepted: _____________________________
Denied: _____________________________

_____________________________
Interviewer
Approved:

______________________________
VPAR/President

Note: Applicant should obtain at least 80% rating in the


Interview to be able to proceed to the next phase.

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