Department of Agriculture

Bureau of Agricultural Research

RDMIC Bldg., Elliptical Rd. Cor. Visayas Ave., Diliman, Q.C. 1104
Phone Nos.: (632) 928-8624 & 928-8505  Fax: (632) 927-5691
Email: rd@bar.gov.ph  Website: http//www.bar.gov.ph

Degree Scholarship Program

APPLICATION FORM
Instructions: Complete the application form and affix you signature where required. Place
NA where not applicable. Check appropriate box. Picture
Date of Application: 2” x 2”

1. Degree: M.S. Ph.D.

2. Course/Field of Specialization:

3. Institution: UP Los Baños USM LSU

UP Diliman MSU – Naawan CLSU
UP Visayas Dela Salle University Siliman University
Ateneo de Manila San Carlos, Cebu BSU

4. Date Admitted: Target Date of Enrollment:

Target Date of Completion:

5. Type of Scholarship Grant Application: Full Support

Additional Support (for those who have availed support from
other agency)

For those who are presently/ previously enrolled, please answer question no. 6
6. School Year Started: Graduate Units Earned:
Graduate Units to be Completed:

7. Name of Applicant:

8. Date of Birth: Age:

9. Home Address:
Phone/Mobile No. Email

10. Sex: Male Marital Status: Single Married

Female Widowed Separated

11. Tertiary Educational Background:

(List chronologically starting with the most recent, use extra sheet when necessary.)
School/University Date Graduated Degree/Course

12. Degree Scholarship(s) enjoyed (Local and Foreign)

Name of Scholarship/Country Degree Duration

DOCUMENT NO.: BAR/QSF-D.01.01 REVISION DATE:

REVISION NO.: 00 EFFECTIVITY DATE: 09 September 2005
Degree Scholarship Program APPLICATION FORM
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13. Work Experience:

(Start with the latest, except for the present employer. Please use extra sheet when necessary.)
Duties and Percent Time Devoted
Employer/Address Position Held Inclusive Dates
to Each*

* Research(R ), Development/Extension (DE), Administration(A), Instruction (I) others

14. Present Employer:

Duties and Percent Time Devoted
Employer/Address Position Held Inclusive Dates
to Each*

* Research(R ), Development/Extension (DE), Administration(A), Instruction (I) others

Nature of Appointment:

15. Office Address:

Phone No.: Fax:

Email:

16. Short Description of Duties and Responsibilities:

17. Please describe briefly how this scholarship will be useful in your work:

DOCUMENT NO.: BAR/QSF-D.01.01 REVISION DATE:

REVISION NO.: 00 EFFECTIVITY DATE: 09 September 2005
Degree Scholarship Program APPLICATION FORM
Page 3 of 4

18. Proposed study plans:

(Proposed major Field of study and specific areas of specialization)

19. Training/Workshop/Conference Attended:

(Use extra sheet for additional entries, using the same format below.)
Nature of Inclusive No. of
Title Location
Participation ** Dates Hrs

** Resource person or trainee

DOCUMENT NO.: BAR/QSF-D.01.01 REVISION DATE:

REVISION NO.: 00 EFFECTIVITY DATE: 09 September 2005
Degree Scholarship Program APPLICATION FORM
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20. On-Going and Completed Researches/Publications:

(Use extra sheet for additional entries, using the same format below.)
Title Designation *** Date

*** Study leader or researcher

I declare under penalties of perjury that the answers given above are true and correct to the
best of my knowledge and belief.

Signature of Applicant

ATTACHMENTS: 1. Certificate of admission from the accredited university 2. Transcript of records obtained from
the latest degree 3. Nomination from the Agency Head indicating that the course/degree is a priority need
of the agency/ in line with the HRD plan of the agency and the applicant is entitled receive salary and
other benefits during the scholarship 4. HRD Plan of the Agency 5. Latest service record certified by the
Chief of Personnel of the Agency 6. List of actual duties and responsibilities certified by immediate supervisor
7. Certification of performance ratings for the last 2 rating periods 8. Curriculum Vitae. For those who are
already enrolled: Include program of course work-indicate the subjects taken and to be taken in all
semester/summer NOTE: Attachments should be in short (8.5” x 11”) bond paper; documents can be reduced
if necessary; Application Form has 4 pages. FOR DETAILS: Call (02) 920-0219.

DOCUMENT NO.: BAR/QSF-D.01.01 REVISION DATE:

REVISION NO.: 00 EFFECTIVITY DATE: 09 September 2005