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CPD Council For - : Application For Crediting of Self Directed And/Or Lifelong Learning

This document is an application form from the Professional Regulation Commission for crediting self-directed or lifelong learning activities toward continuing professional development requirements. The 3-part form collects an applicant's personal and employment information in Part I, requires an acknowledgment of the truth and accuracy of the information provided in Part II, and outlines the process and documentation required for evaluation and approval or disapproval of the application in Parts III. A checklist of supporting documents and additional requirements is also provided, along with procedures for completing and submitting the application within specified timeframes.

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68 views

CPD Council For - : Application For Crediting of Self Directed And/Or Lifelong Learning

This document is an application form from the Professional Regulation Commission for crediting self-directed or lifelong learning activities toward continuing professional development requirements. The 3-part form collects an applicant's personal and employment information in Part I, requires an acknowledgment of the truth and accuracy of the information provided in Part II, and outlines the process and documentation required for evaluation and approval or disapproval of the application in Parts III. A checklist of supporting documents and additional requirements is also provided, along with procedures for completing and submitting the application within specified timeframes.

Uploaded by

bash021
Copyright
© © All Rights Reserved
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Professional Regulation Commission

APPLICATION FOR CREDITING OF SELF DIRECTED AND/OR LIFELONG LEARNING

CPD Council for ____________________


Part I. Personal Information
Name:
Profession:

License No.:

Date Issued:

Valid Until:

Residence Address:
Telephone No.:

Fax No.:

Cellphone No.:

E-mail Address:

Company Name (if employed):

Position:

Company Address:

Telephone no.:

Self-Directed and/or Lifelong Learning:


Invention / Patent
Post-Graduate Studies
Authorship
Diploma Program
Others __________
Part II. Acknowledgment
I HEREBY CERTIFY that the above information written by
me are true and correct to the best of my knowledge and
belief. I further authorize PRC and other agencies to
investigate the authenticity of all the documents presented.
_____________________________
Signature Over Printed Name
_____________________________
Position
_____________________________
Date
Part III. Action Taken
Standards & Inspection Division CPD:
Processed by: _______________
Date
: _______________

Online Training
Seminars / Technical Sessions / Conference
Company sponsored training programs
Professorial Chair

SUBSCRIBED AND SWORN to before me this _____ day


of _______________ 20__ at ____________________,
affiant exhibited to me his/her valid government issued ID
_______________ issued at _______________ on
_______________.

_____________________________
(Notary Public)

Cash Division:
Amount
: ______________
O.R.No./Date : ______________
Issued by
: ______________

Reviewed by:

OIC, Standards and Inspection Division

SID-CPD-03
Rev.01
July 26, 2016
Page 1 of 2

ACTION TAKEN BY THE CPD COUNCIL


Approved
Credit Units Granted: _______________
Disapproved
Deferred pending compliance ______________________________________
______________________________________________________________
______________________________
Chairperson
_____________________________
Member

_____________________________
Member

Date____________________

PROCEDURE FOR CREDITING OF SELF-DIRECTED AND/OR LIFELONG LEARNING


Step 1. Secure Application Form at the Standards and Inspection Division counter (Window 3) or download
at PRC website (www.prc.gov.ph).
Step 2. Fill-out Application Form and comply the required documents. Please provide one (1) set for
receiving copy.
Step 3. Proceed to Standards and Inspection Division processing window for evaluation and assessment.
Step 4. Pay prescribed fee (in cash, Postal Money Order, Managers Check, Bank Draft payable to
Professional Regulation Commission) of Five Hundred Pesos (P 500.00).
Step 5. Submit Application Form with attached supporting documents and one (1) photocopy of official
receipt to the Standards and Inspection Division designated window.
CHECKLIST OF REQUIREMENTS
SUPPORTING DOCUMENTS
(comply only the document/s that is/are required to the application)
[ ] Original and Photocopy of Certificate of Attendance
[ ] Program of Activities
[ ] Diploma / TOR / Certificate of Completion etc.
[ ] Certificate of Patent
[ ] Copy of published material/book
[ ] Certificate of Entitlement / Appointment as Professorial Chair
[ ] Others that may be required by the CPD Council
Additional Requirements:
[ ] Short brown envelope for the Certificate of Accreditation
[ ] One set of metered documentary stamps worth Twenty-Five Pesos (P25.00) to be affixed to the
Certificate of Accreditation. (Available at PRC Customer Service and PRC Regional Offices)
Note:
1. Application for accreditation should be filed no later than five (5) years after completion of degree or
program.
2. Representative/s filing application/s for accreditation and claiming the Certificate of Accreditation in
behalf of the applicant must present a letter of authorization and valid identification cards of both the
authorized signatory and the representative.
3. The period for processing the application is 30 days.
4. If additional requirement/s is/are needed, a period of 7 days is given to submit the same. Failure to
comply within the period shall be construed as abandonment of application and the prescribed fee shall
be forfeited in favor of the government.

SID-CPD-03
Rev.01
July 26, 2016
Page 2 of 2

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