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EPM & ASSOCIATES GRADUATE EXTENSION MIDDLE EAST
ADMISSIONS OFFICE
P.O. Box 79307 Al-Khobar 31952, KSA

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I am applying to begin graduate studies in SCHOOL YR 20____- 20____
I wish to take up the following degree program: / MBA / DBA / DDA / ETEEAP
MM, Major in Educ. / DBM / DPA / Undecided

PERSONAL INFORMATION

Legalname
\ / NAME IN BIRTH CERTIFICATE
Married Name(ifapplicable) LastName FirstName Middle Name / Gender
M F
Permanent address / StreetNo. Street SubdivisionCity
Province/StateCountryZIPCode
Mailing address
(ifnotthesameas the permanent address) / StreetNo. Street SubdivisionCity
Province/StateCountryZIPCode
Phone and e-mail / Residence / ( )
Area Code / Mobile No. / ( )
Area Code / E-mail:
Present
Employment / Employer(company/school/privateindividual) / Job Title
Address / Office Phone
Date of birth / / /
Month Day Year / Age / Place of birth
Citizenship /  Filipino / Others,specify / Religion
Civil Status / Single / Married / Separated / Widowed / Blood type
If married:
Name ofspouse / LastName FirstName Middle Name / Contact
No. / Mobile No / ( )
Area Code
Person to contact in case of emergency / LastName FirstName Middle Name / Contact
Nos. / Residence / ( )
Area Code
Address / Mobile No / ( )
Area Code

ENROLMENT AND PREVIOUS APPLICATION

Have you ever enrolled for graduate studies? Yes  No / If yes, when?
In what school? / For what program of study?
Have you ever applied for graduate studies at the PCU or Lyceum University before? Yes  No
If yes, when and where? / For what program of study?

EDUCATIONAL BACKGROUND – SCHOOLS ATTENDED

Complete Name and Location of All Schools Attended / Dates of Attendance / Degree and
Year Received or Expected
Graduate School
College
High School

ACADEMIC HONORS (COLLEGE/GRAD SCHOOL) OR SPECIAL AWARDS RECEIVED

Award(s)Received / Awarding Institution / Date

IF TEACHER



Currently teaching
On study leave / Employment
status / Permanent
Contractual / Level taught: / Pre-Sch GS HS College Grad Sch
Others, specify ______

TEACHING EXPERIENCE

School(s)/ Address(es) / Subject(s) Taught / Inclusive Dates
Legal Name / Married Name (ifapplicable) /
(NameinBirthCertificate) LastName / FirstName / Middle Name

WORK EXPERIENCE OTHER THAN TEACHING AFTER GRADUATION FROM COLLEGE

Position / Company/Firm / Inclusive Dates

RESEARCH EXPERIENCE

Thesis written. If you wrote a thesis (undergraduate/graduate), what was the subject of your thesis? (Write the full title of the thesis if possible.) If you are an applicant for MA/MS studies, please write your undergraduate thesis topic; if an applicant for a doctoral degree, your master’s thesis topic.

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Other research. If you have done research other than an undergraduate/master’s thesis, please fill up the following tables:

Research Projects / Institution Where Conducted / Position in Project / Inclusive Dates

PUBLISHED RESEARCH PAPERS / UNPUBLISHED RESEARCH PRESENTED

Titles / Publication(s)/Conference(s) / Date

SEMINARS/TRAINING – DIRECTLY RELATED TO YOUR PROPOSED PROGRAM OF STUDY (if any)

Seminars/Workshops
Training Programs Attended / Organizing Institution(s) / Inclusive Dates
Legal Name / Married Name (ifapplicable) /
(NameinBirthCertificate) LastName / FirstName / Middle Name

PLAN FOR STUDY

Do you plan to enroll as a  full-time student?  part-time student?
When do you plan to finish your degree? ______
Who will provide all or most of the funding for your graduate education?
 Self  Parents, relatives  Others, pls. specify: ______
If funding will be provided by a scholarship, specify donor: ______
Scholarship status as of this date:  Still an applicant  Already a grantee

PERSONALESSAY

(The essay should be 1-2 pages long, typed double-spaced, and printed on letter-size bond paper.)

Please write one personal essay that covers the following:

  1. Reasons for graduate study
  1. Reasons for pursuing graduate studies at this time
  2. Reasons for choosing your program of study
  1. Qualities and experiences which will help you or give you difficulties in your chosen program of study
  1. Personal qualities, abilities or special skills
  1. Work experience (life experiences) and previous studies
  2. Constraints or difficulties that you anticipate encountering in your studies
  1. Potential contribution of an LPU or PCU graduate education to your profession and larger society

REFERENCES

(Pleasesee the RECOMMENDATION FOR GRADUATE ADMISSION Form. The instructions given there indicate which names are to be written below.)

Name / Position, Institution, Telephone No. & E-mail Address
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ADDITIONAL INFORMATION REQUIRED

(Please attach a photocopy of your passport at the back of this page.)
Passport No. / Issued at / Expiry date
Type of visa in passport / Validity of visa / / /
Month Day Year
Person to contact in case of emergency
Relation to applicant / Mobile no. / E-mail
Address

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DO NOT FILL UP(For Registrar’s Use)
ID No.
Issued at / Issued on