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APPLICATION FORM
for the Attach here
1 latest passport
SCIENCE AND TECHNOLOGY REGIONAL ALLIANCE OF UNIVERSITIES size picture
FOR INCLUSIVE NATIONAL DEVELOPMENT
(Project STRAND)
GRADUATE SCIENCE AND TECHNOLOGY SCHOLARSHIPS
AY 2017-2018
Form 1
I. PERSONAL INFORMATION
a.
Last Name First Name Middle Name
b.
Permanent Address No. Street Baranggay City/Municipality Province
c.
Zipcode Region District Passport No. E-mail Address
d.
Current Mailing Address
e.
Telephone Nos. (Landline/Mobile) Fax No.
f.
Civil Status Date of Birth Age Sex
g.
Father’s Name Mother’s Name
STRAND CATEGORY TYPE OF APPLICANT (for STRAND 2 only) TYPE OF SCHOLARSHIP APPLIED FOR
STRAND 1 STRAND 2 Student Faculty MS PhD
New Applicant
a. University where you applied/intend
to enrol for graduate studies
b. Course/Degree
Lateral Applicant
a. University enrolled in
b. Course/Degree
*Once accepted in the scholarship program, the scholar must obtain permission to go on a Leave of Absence (LOA) from
his/her employer and become a full-time student. The scholar must submit a letter from his/her employer approving the
LOA.
I hereby certify that all information given above are true and correct to the best of my knowledge.
Signature of Applicant
Date __________________________
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CHECKLIST OF REQUIRED DOCUMENTS SUBMITTED (for staff use only)
Birth Certificate (Photocopy)
Certified True Copy of the Official Transcript of Record
Endorsement from two former professors in college or from two former professors in the MS program
for applicant pursuing a PhD program
If Employed
Recommendation from Head of Agency
Permission to go on a leave of absence (LOA) while on scholarship
Medical Certificate as to health status from a licensed physician with his/her PRC license number indicated
Valid NBI Clearance
Letter of Admission from the Graduate School which should include the evaluation sheet
Program of Study
Distribution of Universities by Type of STRAND
STRAND 1 STRAND 2
BatStateU, CSU, EVSU, PSU, USM BatStateU, CMU, MMSU, MSU-IIT NVSU,
SLU, SMU, USEP, USTP CDO
SCIENCE AND TECHNOLOGY REGIONAL ALLIANCE OF UNIVERSITIES
FOR INCLUSIVE NATIONAL DEVELOPMENT
(Project STRAND)
GRADUATE SCIENCE AND TECHNOLOGY SCHOLARSHIPS
AY 2017-2018
CAREER PLANS
b.1) Briefly discuss your proposed research area/s
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b.2) Future Plans (After Graduation)
Form 2
(For those who are currently employed)
Instructions to the Applicant: Please complete this form and give this to the Head of the
Institution/Supervisor for certification. Enclose the accomplished form in your application.
This is to certify that the person whose name appears below is employed in the
institution as indicated but is allowed to go on a leave of absence should he/she qualify
for a scholarship under Project STRAND.
Name of Applicant:
__________________________________________________________________
(Last Name) (First Name) (Middle Name)
Designation:_______________________________________________________________
Sending Institution: _________________________________________________________
Address:__________________________________________________________________
Program Applied for: ________________________________________________________
Issued upon the request of the applicant as a requirement for application DOST-SEI Graduate
Scholarship under the Science and Technology Regional Alliance for Inclusive National
Development (STRAND).
Position/Title: ____________________________________
Form 3
This certification is issued in connection with his/her application for the DOST-SEI
Graduate Scholarship under the Science and Technology Regional Alliance for Inclusive
National Development (STRAND).
_________________________________ _____________________________________
Name of Health Agency Name (Print) and Signature of Medical Officer
_________________________________ _____________________________________
Address Official Designation/License No.