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Application Form for Accreditation of CPD Program
PRC application form for accreditation of continuing professional development
Your Browser Doesn't Support Canvas. Showing the Text Content of the PDF Instead: Professional Regulation Commission
APPLICATION FOR ACCREDITATION OF CPD PROGRAM
CPD Council for ____________________
Part I. General Information
Name of Provider:
Accreditation No.:
Expiration Date:
Contact Person:
Designation:
Contact No.:
Date of Application:
Proposed Program:
Seminar
Seminar/Workshop
Title of the Program:
Residency Training
Tours & Visits
Others __________
Date to be offered:
Time / Duration:
Place / Venue:
No. of times program to be conducted:
Course Description:
Objectives:
Target Participants / No.:
Registration / Seminar Fee to be collected:
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
Continuing Professional Development Section:
Processed by:_______________
Date
:_______________
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:
___________________________________________
Chief, Regulation Division
ACTION TAKEN BY THE CPD COUNCIL
Approved for _____ Credit Units
Accreditation No. _______________
Disapproved
Deferred pending compliance ______________________________________
______________________________________________________________
______________________________
Chairperson
_____________________________
Member
_____________________________
Member
Date____________________
CPDD-02
Rev. 02
November 22, 2017
Page 1 of 2
PROCEDURE FOR ACCREDITATION OF CPD PROGRAM
Step 1. Secure Application Form at Window 15, 16, or 17 of the Registration Division, PRC-PICC, or at any
of the Regional Offices, 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 Window 15, 16, or 17 of the Registration Division, PRC-PICC, or at any of the
Regional Offices for evaluation and assessment.
Step 4. Pay prescribed fee (in cash, Postal Money Order, Manager’s Check, Bank Draft payable to
Professional Regulation Commission) of One Thousand Pesos (P 1,000.00).
Step 5. Submit Application Form with attached supporting documents and photocopy of official receipt to
Window 15, 16, or 17 of the Registration Division, PRC-PICC, or at any of the Regional Offices.
Step 6. Verify your application after ___days from time of submission by calling telephone numbers:
310-10-48 (PRC-Main)/810-84-15 (PRC-PICC), or email at prc.cpdsecretariat@gmail.com
CHECKLIST OF REQUIREMENTS
SUPPORTING DOCUMENTS
[ ] Specific course Objectives stating competencies to be gained from program
[ ] Evaluation tool specific to course objectives set
[ ] Program of Activities showing time/duration of topics/workshop
[ ] Resume of Speakers for program applied for, showing expertise in the topic/s; show certificates or
citations (if any)
[ ] Current Prof. ID of speaker if registered professional; if foreigner, current Special Temporary Permit
(if applicable)
[ ] Breakdown of expenses for the conduct of the program
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)
[ ] Soft copy of the Application including supporting attachments in PDF format saved in CD.
[ ] Pre-paid pouch (preferably from Philpost) for applications filed in Regional Offices only.
Note:
1. Application for accreditation should be filed 45 days before the offering of the program/training.
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 45 days.
4. If additional requirement/s is/are needed, a period of 15 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.
CPDD-02
Rev. 02
November 22, 2017
Page 2 of 2
