Document Code: OETEEAP-F-EAF

Document Title: Page No: 1 of 8

MANUEL S. ENVERGA UNIVERSITY FOUNDATION ETEEAP Application
Form
An Autonomous University Revision No.: 3
LUCENA CITY Effectivity Date: September 2022
Prepared by: OETEEAP
Reviewed by: QMR
Department: OFFICE OF THE EXPANDED TERTIARY EDUCATION Approved by: President
EQUIVALENCY AND ACCREDITATION PROGRAM (ETEEAP CENTER)

ETEEAP APPLICATION FORM

1x1
Picture ID

INSTRUCTIONS: Please type or clearly print your answers to all questions. Provide complete and
detailed information required by the questionnaire. All the declarations that you make are under oath.
Discovery of any false claim in this application form will disqualify you from participating in the
program.

I. PERSONAL INFORMATION

1. NAME (Last Name, First Name, Middle Name)

Villafuerte, Adrian Rudolf, Luna
2. Address : 468, Hoyo St., Tartaria, Silang, Cavite
3. Zip Code : 4118
4. Telephone No(s). :
5. Mobile Number: 09502212976
6. Email address: [email protected]
7. Messenger: Adrian Luna Villafuerte
8. Age: 24
9. Birth Date : 03/20/1999
10. Birthplace : Silang, Cavite
11. Civil Status : Single
12. Sex : Male Nationality : Filipino
13. Languages and Dialects Spoken : Tagalog/English

14. Degree Program or field being applied for :

First Priority : BS in Electronics Engineering

Second Priority : BS in Computer Engineering
Third Priority : BS in Industrial Engineering
15. Statement of your goals, objectives or purposes in applying for the degree.
To acquire skills and knowledge that are vital in my workplace and everyday life
And also, to develop objectivity, precise decision making, discipline, and logical thinking
that are key in engineering jobs.

16. Indicate how much time you plan to devote for personal learning activities so that you can
finish the requirements in the prescribed program. Be specific.
My work starts at around 7am to 4pm, Monday to Friday, I would focus on the

17. For overseas applicants, describe how you plan to obtain accreditation/equivalency. (e.g.
when you plan to come to the Philippines)
___________________________________________________________________________
___________________________________________________________________________
________________________________________________
How soon do you need to complete equivalency/accreditation?
 Document Code: OETEEAP-F-EAF
Document Title: Page No: 2 of 8
MANUEL S. ENVERGA UNIVERSITY FOUNDATION ETEEAP Application
Form
An Autonomous University Revision No.: 3
LUCENA CITY Effectivity Date: September 2022
Prepared by: OETEEAP
Reviewed by: QMR
Department: OFFICE OF THE EXPANDED TERTIARY EDUCATION Approved by: President
EQUIVALENCY AND ACCREDITATION PROGRAM (ETEEAP CENTER)

_____ less than one (1) year _____ 1 year

II. EDUCATION:

This section will require you to provide information on your past formal, non-formal and
informal learning experiences.

1. Formal Education

Course/Degree Program Name of School/Address Inclusive Dates of

Attendance

Note : All entries should be supported by authenticated photocopy of appropriate

certificates/documents obtained from the institution through the program.

2. Non-Formal Education

Non-formal education refers to structured and short-term training programs conducted for a
particular purpose such as skills development, values orientation, and the like.

Title of Training Program Title of Certificate Obtained Inclusive Dates of

Attendance

Note : All entries should be supported by authenticated photocopy of appropriate

certificates/documents obtained from the institution through the program.

3. Other Certification Examinations

Please give detailed information on certification examinations taken for vocational and other
skills.

Title of Certification Name/Address of

Date Certified Rating
Examination Certifying Agency

Note : All entries should be supported by authenticated photocopy of appropriate

certificates/documents obtained from the institution through the program.

III. PAID WORK AND OTHER EXPERIENCES

1. Post/Designation
_____________________________________________

2. Inclusive Dates of Employment

From : __________________ to __________________
 Document Code: OETEEAP-F-EAF
Document Title: Page No: 3 of 8
MANUEL S. ENVERGA UNIVERSITY FOUNDATION ETEEAP Application
Form
An Autonomous University Revision No.: 3
LUCENA CITY Effectivity Date: September 2022
Prepared by: OETEEAP
Reviewed by: QMR
Department: OFFICE OF THE EXPANDED TERTIARY EDUCATION Approved by: President
EQUIVALENCY AND ACCREDITATION PROGRAM (ETEEAP CENTER)

3. Name and Address of Company

__________________________________________________
__________________________________________________

4. Terms/Status of Employment
______________________________

5. Name and Designation of Immediate Supervisor

_______________________________________________
_______________________________________________

6. Reason(s) for moving on to the next job.

_________________________________________________________________
_________________________________________________________________
_________________________________________________________________

7. Describe actual functions and responsibilities in position occupied:

___________________________________________________________________________
___________________________________________________________________________
________________________________________________

8. In case of self-employment, name three (3) reference persons; including their current
addresses and contact numbers.
_________________________________________________
_________________________________________________
_________________________________________________

Note : Use another sheet if necessary, following the above format.

IV. HONORS, AWARDS, AND CITATIONS RECEIVED

In this section, please describe all the awards you have received from schools,
community and civic organizations, as well as citations for work excellence, outstanding
accomplishments, community service, etc.

1. Academic Award

Name and Address of Conferring

Award Conferred Date Awarded
Organization
 Document Code: OETEEAP-F-EAF
Document Title: Page No: 4 of 8
MANUEL S. ENVERGA UNIVERSITY FOUNDATION ETEEAP Application
Form
An Autonomous University Revision No.: 3
LUCENA CITY Effectivity Date: September 2022
Prepared by: OETEEAP
Reviewed by: QMR
Department: OFFICE OF THE EXPANDED TERTIARY EDUCATION Approved by: President
EQUIVALENCY AND ACCREDITATION PROGRAM (ETEEAP CENTER)

2. Community and Civic Organization Award/Citation

Name and Address of Conferring

Award Conferred Date Awarded
Organization

3. Work Related Award/Citation

Name and Address of Conferring

Award Conferred Date Awarded
Organization

V. CREATIVE WORKS AND SPECIAL ACCOMPLISHMENTS

In this section, enumerate the various creative works you have accomplished and other
special accomplishments. Examples of these are inventions, published and unpublished literary
fiction and non-fiction writings, musical work, products of visual performing arts, exceptional
accomplishments in sports, social, cultural and leisure activities, etc. which can lead one to
conclude the level of expertise you have obtained on certain fields of interest. Include also
participation in competitions and prizes obtained.

1. Description : _____________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
_______________________________________
2. Date Accomplished : ________________________
3. Name and Address of Publishing Agency (if written, published work), or an
Association/Institution which can attest to the quality of the work.
______________________________________________________
___________________________________________________________________________
_________________________________________________________

Note : Use additional sheet if necessary, following the same format.

VI. LIFELONG LEARNING EXPERIENCE

 Document Code: OETEEAP-F-EAF
Document Title: Page No: 5 of 8
MANUEL S. ENVERGA UNIVERSITY FOUNDATION ETEEAP Application
Form
An Autonomous University Revision No.: 3
LUCENA CITY Effectivity Date: September 2022
Prepared by: OETEEAP
Reviewed by: QMR
Department: OFFICE OF THE EXPANDED TERTIARY EDUCATION Approved by: President
EQUIVALENCY AND ACCREDITATION PROGRAM (ETEEAP CENTER)

In this section, please indicate the various life experiences from which you must have derived
some learning experience. Please include here unpaid volunteer work.

1. Hobbies/Leisure Activities

Leisure activities which involve rating of skills for competition and other purposes (e.g. “belt
concept in tae-kwon-do) may also indicate your level for ease of evaluation. On the other
hand, watching Negosiyete on a regular basis can be considered a learning opportunity.

___________________________________________________________________________
___________________________________________________________________________
________________________________________________

2. Special Skills

Note down those special skills which you think must be related to the field of study you want
to pursue.

___________________________________________________________________________
___________________________________________________________________________
________________________________________________

3. Work-Related Activities

Some work-related activities are occasions for you to learn something new. For example,
being assigned to projects beyond your usual job description where you learned new skills
and knowledge. Please do not include formal training programs you already cited. However,
you may include here experiences which can be classified as on-the-job training or
apprenticeship.
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

4. Volunteer Activities

List only volunteer activities that demonstrate learning opportunities, and are related to the
course you are applying for credit. (e.g. counseling programs, sports coaching, project
organizing or coordination, organizational leadership, and the like)
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
__________________________________________________________________________

5. Travels : Cite places visited and purpose of travel

Include a write-up of the nature of travel undertaken, whether for leisure, employment,
business or other purposes. State in clear terms what new learning experience was obtained
from these travels and how it helped you become a better person.
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
VII. To sum up, please write an essay on how your attaining a degree contribute to your personal
development, your community, your workplace, society, and country?
______________________________________________________________________________
______________________________________________________________________________
 Document Code: OETEEAP-F-EAF
Document Title: Page No: 6 of 8
MANUEL S. ENVERGA UNIVERSITY FOUNDATION ETEEAP Application
Form
An Autonomous University Revision No.: 3
LUCENA CITY Effectivity Date: September 2022
Prepared by: OETEEAP
Reviewed by: QMR
Department: OFFICE OF THE EXPANDED TERTIARY EDUCATION Approved by: President
EQUIVALENCY AND ACCREDITATION PROGRAM (ETEEAP CENTER)

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I declare under oath that, the foregoing claims and information I have disclosed are true and
correct. Done in ________________________________, on this ______ day of
________________________.

Signed :

____________________________________________
Printed Name and Signature of Applicant

Community Tax Certificate ________________________

Issued on _____________________________ at ____________________________
 Document Code: OETEEAP-F-EAF
Document Title: Page No: 7 of 8
MANUEL S. ENVERGA UNIVERSITY FOUNDATION ETEEAP Application
Form
An Autonomous University Revision No.: 3
LUCENA CITY Effectivity Date: September 2022
Prepared by: OETEEAP
Reviewed by: QMR
Department: OFFICE OF THE EXPANDED TERTIARY EDUCATION Approved by: President
EQUIVALENCY AND ACCREDITATION PROGRAM (ETEEAP CENTER)

What is the ETEEAP?

The Expanded Tertiary Education Equivalency and Accreditation Program (ETEEAP) is a

comprehensive program of identifying, assessing, validating and assigning equivalent undergraduate level
of prior learning from formal, non-formal and informal training and relevant work experiences and
completion of competency enrichment and other program requirements toward the final granting of
appropriate undergraduate academic degrees.

By establishing equivalency competence standards and a comprehensive assessment system

employing written test, interview, skills demonstration and other creative assessment methodologies,
higher education institutions may administer competency-based evaluation. A Panel of Assessors is
convened to determine the candidates’ knowledge, skills and attitudes relevant to a particular discipline,
and consequently equivalent credits and appropriate certificates and degrees are awarded by deputized
higher education institutions.

The mandate to implement the program is embodied in Executive Order 330 issued by President
Fidel V. Ramos on May 13, 1996 as an offshoot of the recommendation of the First Employment Summit
in September 1995.

1. Qualification of the Individual Applying for Equivalency and Accreditation.

1.1. Completion of secondary school program as evidenced by a high school diploma, or the
PEPT/ALS A & E result stating “qualified to enter first year college”;

The admission of individual applicants in relation to K-12 implementation, shall be based on the
following CHED Memorandum Orders (CMOs):

1.2. CMO No.10, s.2017 Policy on Students Affected by the Implementation of the K to
12 Program and the New General Curriculum

1.3. CMO No. 105 a. 2017: Policy on the Admission of Senior High School Graduates to
the Higher Education Institutions Effective Academic Year 2018-2019

1.4. CMO No.10, s.2018 Policy on Alternative Learning System Completers and
Passers of the A & E Test in Relation to the implementation of the K to 12 Basic
Education Program Memorandum from the Chair entitled: Accommodation of
Lifelong Learners in College for 2017-2018 and SY 2018-2019 (June 13,2017)

1.5. A Filipino and at least twenty-three (23) years old as supported by a PSA
authenticated birth certificate.

1.6. For an employed applicant, they should have an aggregate of at least five (5) years
in the industry related to the academic degree program or discipline where
equivalency of learning is sought; and

1.7. For an individual with proven competency/ies but currently unemployed, they
should submit a notarized service record or other corroborative documents such as
Income Tax Return (ITR), SSS, PhilHealth, and Pag-IBIG records and in the
absence of such proofs, pass the competency assessment administered as a pre-
qualifying requirement of the deputized higher education institution.

2. Application for Grant of Second Degree through ETEEAP.

 Document Code: OETEEAP-F-EAF
Document Title: Page No: 8 of 8
MANUEL S. ENVERGA UNIVERSITY FOUNDATION ETEEAP Application
Form
An Autonomous University Revision No.: 3
LUCENA CITY Effectivity Date: September 2022
Prepared by: OETEEAP
Reviewed by: QMR
Department: OFFICE OF THE EXPANDED TERTIARY EDUCATION Approved by: President
EQUIVALENCY AND ACCREDITATION PROGRAM (ETEEAP CENTER)

A bachelor’s degree holder may apply for equivalency and accreditation of prior and work-based
learning towards the grant of up to the second degree only; provided however, that such sources of
learning are related to the second degree being sought under ETEEAP.

3. Procedure for Application and Assessment of Learning.

The procedure for application and assessment of learning should consist, at a minimum, of the
following:

3.1. The individual applicant secures the application form from any deputized HEI, or downloads the
form from the CHED website, www.ched.gov.ph, submits the accomplished form, along with the
supporting evidences that established his/her qualifications for the program, and pays appropriate
application fees to a deputized HEI of his/her choice.

3.2. The accepting HEI reviews the application, interviews the applicant and informs him/her in writing of
the results of the review and interview.

3.3. Upon approval of the application, the deputized HEI requires the applicant (candidate) to prepare and
submit his/her portfolio with the assistance of the institution’s career counselor/adviser within an
agreed period of time. This portfolio should include descriptions of prior learning in the context of
learning outcomes. The employer concerned should certify all experiences cited by the candidate as
having been completed whole in employment;

3.4. Upon receipt of the portfolio, the HEI convenes a panel of assessors to conduct the evaluation. Tests
or other forms and instruments of assessments, e.g. interviews, actual demonstration of claimed
knowledge and skills, written examination, and others that are appropriate to the candidate’s needs
may be used as needed;

3.5. After completing the evaluation, the panel of assessors determines the amount of equivalent credit
that will be awarded to the candidate by matching the demonstrated training and learning from prior
learning of the candidate with the learning outcomes and standards of the subject or course for which
the candidate seeks accreditation and equivalency. A rubric or a similar tool shall be developed for
the purpose;

3.6. A candidate may choose from a variety of learning pathways including E-Learning, Mobile learning,
or Blended learning in the completion of his/her deficiencies while outside the institution’s physical
location. Institutions may use LMS and/or any mode of communication not limited to social media
facilitating the acquisition,completion not limited to social media facilitating the acquisition,
completion, and assessment of student’s learning.

3.7. The accomplished rubric or any situation or any similar instrument that documents the learning of the
candidates from prior learning should be maintained as permanent official record in the ETEEAP
Office of the institution.

3.8. After satisfying all the learning outcomes and appropriate assessment criteria for the course, and
having complied with the requirements prescribed by CHED and the institution for completion of the
course, the candidate is awarded the appropriate equivalency credit for an academic degree;

3.9. Graduates of the ETEEAP programs are qualified to take the appropriate licensure examinations,
unless otherwise provided by law.