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Dissertation Grant Application Form

CHED application form for dissertation grant

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CHED DISSERTATION GRANT

1.

Name nominee/applicant ______________________________________
(First)
(Middle)
(Last)

2.
3.
4.
5.
6.
7.

Date and place of birth
Mailing/Office address and telephone/fax number
Residence and telephone number
E-mail address
Civil status (If married, please indicate spouse’s name and children’s name/s)
Educational background (Indicate school/university address, degree and year obtained, inclusive
dates of attendance, honors/awards received)
Present position
Subjects currently taught
Previous positions in chronological order
Title of dissertation proposal
Discipline of study
Degree program
Name and address of University/College where the candidate grantee is enrolled
Name of Dissertation Adviser
Work Plan/Time Table

8.
9.
10.
11.
12.
13.
14.
15.
16.

Activities
Approval of Dissertation Proposal
Data Collection and Encoding
Data Analysis
Dissertation Writing
Expected Date of Defense
Expected Completion Date of Doctoral Program

Expected Date of Completion

17. Total Amount and Detailed Budget of Financial Assistance sought from CHED Dissertation Grant
Item

Amount

* Please indicate other source (s) of financial support including the amount

18. Dissertation Panel/Committee Members
19. Awards received (indicate year received and name of awarding institution/organization)

20. GPA in the Course leading to the program applied for
21. Research Publications (Give complete citation and include manuscript in press)
22. Research papers and studies completed or in progress (indicate where or when conducted, date
completed or expected date of completion, and include only those not listed in item 20)
23. Membership in professional organizations (indicate position/nature of involvement)
24. Conferences/seminars and extent of participation, i.e. whether as chairperson, resource person,
convenor, participants, etc.

This is to certify the correctness of the information presented above.

______________________________________________
Name & Signature of the Faculty Applicant
Date: ________________

_______________________________
Name & Signature of the School Head
Date: _____________

Note: Please submit two (2) copies of the accomplished application form including copies of (a) approved
dissertation proposal including a one-page abstract; (b) two 2”x2” photographs; (c) letter of
recommendation from the dissertation adviser; (d) endorsement letter from the applicant’s mother
institution; and (e) photocopy of the latest enrollment/registration form.
 
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