CPD FORM NO.

02
Rev. 03-19-2013

Republic of the Philippines

Professional Regulation Commission
Manila

CPD COUNCIL FOR

_______________________

Application Form for Accreditation of CPD Program

Name of CPD Provider ______________________________________________

Accreditation No. _________________ Expiration Date _____________________
Contact person __________________ Designation ________________________
Contact Number __________________Date of Application __________________
Proposed Program
Seminar
Tours & visits

Seminar/Workshop
Technical Lecture
Scientific Meeting

Subject Matter Meeting

Non Degree Training
Others _______________

Title of the Program:

Date to be Offered:
Place/Venue:

Time/Duration:
No. of times program to be conducted:

Course Description:

Objectives:

Target Participants/No.:

Registration/Seminar Fee to be
collected:

Documents Required for Submission to CPD Council:

Specific course objectives stating competencies to be gained from program
Evaluation tool specific to course objectives
Program of Activities showing time/duration of topics/workshop
Resume of speakers for program applied for showing expertise in topic/s
of program; show certificates or citations (if any)
Current Prof. ID of speaker if registered professional; if foreigner, current
Special Temporary Permit, if applicable
Breakdown of expenses for the conduct of the program
___________________________________
Signature Over Printed Name
________________________
Position
________________________
Date
&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&
Processed by: ______________
Date
: ______________
Amount Paid: _______________
O.R. No./Date: ______________
Cash Section: _______________

CPD FORM NO. 02

Rev. 03-19-2013

ACTION TAKEN

Approved for ______Credits Units

Accreditation No. _______________

Disapproved
Deferred pending compliance ___________________________________
__________________________________________________________

____________________
Chairperson
_______________________________

________________________________

Member

Member

________________
Date

Note: Application form should be submitted at least thirty (30) days before
the date of offering.