Form No. 2.

0- PDS
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EXPANDED TERTIARY EDUCATION EQUIVALENCY AND ACCREDITATION PROGRAM (ETEEAP)

LICEO DE CAGAYAN UNIVERSITY

PERSONAL DATA SHEET

General Considerations before proceeding to use this form: 2X2

1. Fill in the blank spaces with the required information.

2. Put a check (√) mark in the appropriate box for certain questions.
3. Fill all the items with information, if applicable, because it might be useful for equivalency and accreditation evaluations.
4. Make sure that all information offered and declared are true and can be verified.
5. False claim if found to be intentional and offered to deceive for purposes of equivalency and accreditation will be used as evidence for disqualification,
disbarment from the program, or forfeiture of degree awarded through this program.

Program Applied:
I. Personal Information
A. Applicant’s Name:
Last Name:
First Name:
Middle Name:
B. Permanent Home Address:
Zip Code:
Contact Number(s):
C. Birth Date: D. Place of Birth: E. Age:
D. Civil Status:
H. Gender: G. Nationality: Filipino / Others:
I. Citizenship: FILIPINO (as basic requirement)
J. Religion: J. Languages/ Dialects Spoken:
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EXPANDED TERTIARY EDUCATION EQUIVALENCY AND ACCREDITATION PROGRAM (ETEEAP)

LICEO DE CAGAYAN UNIVERSITY

K. Father’s Name: Address:

L. Mother’s Maiden Name: Address:
II. Educational Background and Achievements
A. Formal Education:
a. Elementary Level
Name of School:
Address:
Year of Entry: Year of Graduation:
b. High School Level / School last attended
Name of School:
Address:
Year of Entry: Year of Graduation: Level Attained (If unfinished):
c. If High School is finished or acquired through Philippine Education
Test Equivalency Result: and Year Issued: Placement Grade or Year Level :
d. If vocational or short term Formal Education is acquired or finished
1. Course or degree program enrolled:
Name of School/Institution:
School/Institution’s Address:
2. Course or degree program enrolled: Name of School/Institution:
School/Institution’s Address:
e. College Level/School last attended
Name of School: Address:
Year of Entry: Year of Graduation: Year Level Attained (If unfinished):
Course taken: Course finished:
If not Finished, year level last attended:
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EXPANDED TERTIARY EDUCATION EQUIVALENCY AND ACCREDITATION PROGRAM (ETEEAP)

LICEO DE CAGAYAN UNIVERSITY

B. Non Formal Education:

a. Organized workplace-based training, seminars, lectures, workshops, and non-credit courses participated in related to the program applied.

Title of event Event venue Event date Sponsoring Title of Certificate Role/
Organization/ Obtained Participation in the
Association event
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EXPANDED TERTIARY EDUCATION EQUIVALENCY AND ACCREDITATION PROGRAM (ETEEAP)

LICEO DE CAGAYAN UNIVERSITY

C. Informal Education:
A. Employment History and Work Experiences
a. Previous employment and work experiences: Provide a brief information that may be helpful in your application and maybe
given credits, and are related to the program applied.
I. First previous employment:
Name of Company:
Address:
Designation/Position:
Employment Status:
Inclusive period of employment (From/To):
Name of Immediate Supervisor:
Contact No. of Supervisor:
Provide brief job description of Specific Duties and Responsibilities (Write as many):
1.
2.
3.
II. Second previous employment:
Name of Company:
Address:
Designation/Position:
Employment Status:
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EXPANDED TERTIARY EDUCATION EQUIVALENCY AND ACCREDITATION PROGRAM (ETEEAP)

LICEO DE CAGAYAN UNIVERSITY

Inclusive period of employment (From/To):

Name of Immediate Supervisor:
Contact No. of Supervisor:
Provide brief job description of Specific Duties and Responsibilities (Write as many):
1.
2.
3.

III. Current employment and work experiences:

Name of Company:
Address:
Designation/Position:
Employment Status:
Inclusive period of employment (From/To):
Name of Immediate Supervisor:
Contact No. of Supervisor:
Provide brief job description of Specific Duties and Responsibilities (Write as many):
1.
2.
3.
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EXPANDED TERTIARY EDUCATION EQUIVALENCY AND ACCREDITATION PROGRAM (ETEEAP)

LICEO DE CAGAYAN UNIVERSITY

a. Self-employment: In case of self-employment, describe the work and your experiences that you think are related to the
program applied.

Work/Employment Description Actual Functions and Responsibilities

b. Provide at least three persons who can attest and testify your self-employment for verification.
Name: _______________________________________ Address: _____________________________________ Contact
No.___________________________________ Relation to the Applicant: _______________________
Name: _______________________________________ Address: _____________________________________ Contact
No.___________________________________ Relation to the Applicant: _______________________
Name: _______________________________________ Address: _____________________________________ Contact
No.___________________________________ Relation to the Applicant: _______________________
D. Volunteer Activities
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EXPANDED TERTIARY EDUCATION EQUIVALENCY AND ACCREDITATION PROGRAM (ETEEAP)

LICEO DE CAGAYAN UNIVERSITY

a. List down and describe volunteer activities done and participated in that you think provided learning, skills, and competencies which are related to the
program applied, like consultancy, counseling program, coaching, organizing, leadership, OJTs, apprenticeships, and the like.

Volunteer Activities Brief Description of Knowledge and skills gained

1.

2.

3.

III. Proficiency Certification Awarded

(Awarded by Government Regulatory Body, Licensed Agency in the field, and the like)

Title of Certification Examination Certifying Agency/Body Date of Certification Ratings/Score

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EXPANDED TERTIARY EDUCATION EQUIVALENCY AND ACCREDITATION PROGRAM (ETEEAP)

LICEO DE CAGAYAN UNIVERSITY

IV. Academic Honors, Awards, Citations Received

(Awarded by Formal Academic Institutions, Departments, College, Sector and the like)

Title of Honors, Awards, Citations Conferring Academic Institution Address of Conferring Academic Institution Date Awarded
received
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EXPANDED TERTIARY EDUCATION EQUIVALENCY AND ACCREDITATION PROGRAM (ETEEAP)

LICEO DE CAGAYAN UNIVERSITY

V. Non-academic Honors, Awards, Citations Received

( Awarded by Civil Society Organizations and Associations which are non-academic in character)

Title of Honors, Awards, Citations Conferring Organization/ Address of Conferring Organization/Association Date Awarded
received Association
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EXPANDED TERTIARY EDUCATION EQUIVALENCY AND ACCREDITATION PROGRAM (ETEEAP)

LICEO DE CAGAYAN UNIVERSITY

VI. Others Meritorious Achievements and Accomplishments

A. Work related merits: This includes performance rating, leadership award, employment award, top-seller, and the like, that are
related to the program applied, and not mentioned above.

Title of Merit received Conferring Address of Conferring Date Awarded

Organization/Institutions/Office Organization/Association/Institutions/Office
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EXPANDED TERTIARY EDUCATION EQUIVALENCY AND ACCREDITATION PROGRAM (ETEEAP)

LICEO DE CAGAYAN UNIVERSITY

B. Work related qualities, values, and competencies. Please provide your personal view of your three (3) best performances, or
accomplishments which are not appropriately recognized by organizations or institutions. This may help guide the Assessors in
knowing your qualities, values, and competencies.

Best Performance, Values, Qualities Descriptions

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EXPANDED TERTIARY EDUCATION EQUIVALENCY AND ACCREDITATION PROGRAM (ETEEAP)

LICEO DE CAGAYAN UNIVERSITY

C. Special skills and talents. These are abilities which you consider as unique and excellent because it aided you in the performance of
your work or which you think are highly related to the program you applied for.

Special skills and talents Descriptions

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EXPANDED TERTIARY EDUCATION EQUIVALENCY AND ACCREDITATION PROGRAM (ETEEAP)

LICEO DE CAGAYAN UNIVERSITY

VII. Certificate of Inventions, Publications, Discovery, Business Registration

a. For Inventions and Discovery

Title of Certification Certifying Agency/Body Date of Certification

b. For Publications and Citations in Publications

Title of Certification of Publication Certifying Publishers Title/Name of Book or E-Book Date of Certification
Address
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EXPANDED TERTIARY EDUCATION EQUIVALENCY AND ACCREDITATION PROGRAM (ETEEAP)

LICEO DE CAGAYAN UNIVERSITY

c. For Business Registration

Name of Business and certificate of registration Certifying Agency/Body Date of Certification Registration
Number

VIII. Membership in Professional and Non-Professional Organizations/Associations

a. Membership in Professional Organizations that are related to the program applied.

Name of Organization Address of the Organization Role/Position Date of Membership

(From /To)
/
/
/
/
IX. Hobbies and Leisure
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EXPANDED TERTIARY EDUCATION EQUIVALENCY AND ACCREDITATION PROGRAM (ETEEAP)

LICEO DE CAGAYAN UNIVERSITY

a. Hobbies and leisure that are contributing to the improvement of your skills, attitudes, qualities, and abilities which provide
learning opportunities.

Hobbies and Leisure Learning gained from doing the hobbies

X. Travel and Cultural Exposures

a. Provide a brief description of the travels made and explain the learning acquired through the exposure which are helpful in developing your attitude, values, skills,
behavior, knowledge, ability, and competencies.

Place of Visit Inclusive dates Purpose of Travel Learning acquired

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EXPANDED TERTIARY EDUCATION EQUIVALENCY AND ACCREDITATION PROGRAM (ETEEAP)

LICEO DE CAGAYAN UNIVERSITY

XI. Intentions, Purposes, and Justifications for Interest in ETEEAP

1. Why are you applying for the Degree?
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
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EXPANDED TERTIARY EDUCATION EQUIVALENCY AND ACCREDITATION PROGRAM (ETEEAP)

LICEO DE CAGAYAN UNIVERSITY

____________________________________________________________________________________________________________
________________________________________________.

2. Why apply through ETEEAP?

____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
________________________________________________.

3. How much time would you devote for the completion of the program if accepted?
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
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EXPANDED TERTIARY EDUCATION EQUIVALENCY AND ACCREDITATION PROGRAM (ETEEAP)

LICEO DE CAGAYAN UNIVERSITY

____________________________________________________________________________________________________________
___.
4. Identify who sponsors or funds your ETEEAP course if accepted.
Self Scholarship/Grant Current Employer Family member(s) Others ___________
5. What is your projected time to finish the ETEEAP degree?
1 Semester 1 Year 18 Months 2 Years More than 2 Years

End of Application

OATH OF HONESTY
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EXPANDED TERTIARY EDUCATION EQUIVALENCY AND ACCREDITATION PROGRAM (ETEEAP)

LICEO DE CAGAYAN UNIVERSITY

I swear that all information and claims declared in this personal data sheet are done by me personally, knowingly, and intelligently, without coercion and
intention to deceive the Liceo de Cagayan University and the ETEEAP, together with its staff, pool of experts, and the Government of the Republic of the
Philippines, specifically the Commission on Higher Education (CHED), and fully aware of the repercussions for violating this oath.
Done in Liceo de Cagayan University, R.N. Pelaez Blvd, Cagayan de Oro City, this _______ day of ____________, _____________.

AUTHORIZATION
I am authorizing LDCU ETEEAP to inquire into the veracity of my claims in this personal data sheet. I am allowing also any person, institution, office, and
school mentioned directly and indirectly in this application form to release any information/records that LDCU ETEEAP may inquire and request in relation to this
application. The LDCU ETEEAP may use such information in the processing of this application.

Signed:

_______________________________________
Signature over printed name of Applicant
Community Tax Certificate
Number: _________________________
Date Issued: ______________________
Place of Issue: _____________________

Received by:
_______________________________________
Signature over printed name of Office-in-Charge