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SOUTHEAST ASIAN REGIONAL CENTER FOR
GRADUATE STUDY AND 2”x2"
RESEARCH IN AGRICULTURE (SEARCA)
Los Baños, Laguna 4031, Philippines
URL: http://www.searca.org; Email: gsd@agri.searca.org

SEARCA SCHOLARSHIP APPLICATION FORM

(Please type or write in block letters. To be prepared in triplicate)

Degree/Course applied for (please check): MS PhD

Major Field (please state): __________________________________
Duration: From __________________ To ____________________
Desired Study Post /University (pls. check):
University of the Philippines Los Baños (UPLB), Philippines
University of the Philippines Diliman (UPD), Philippines
University of the Philippines in the Visayas (UPV), Philippines
Kasetsart University (KU), Thailand
Universiti Putra Malaysia (UPM), Malaysia
Institut Pertanian Bogor (IPB), Indonesia
Universitas Gadjah Mada (UGM), Indonesia

A. PERSONAL INFORMATION

1. Full Name: ___________________________________________________________

(Family) (First Name) (Middle Name)
2. Nationality: ______________________________________________________________

3. Home Address: ___________________________________________________________

___________________________________________________________
___________________________________ Tel: ____________________
Fax: ___________________
Email: _________________
4. Country: ___________________________________________________________

5. Employer (Institution or Company): _________________________________________

___________________________________________________________

6. Employer’s Address: _______________________________________________________

____________________________________________________________
___________________________________ PO Box: _______________
Tel: ____________________
Fax: ___________________
Email: __________________
7. Date of Birth: ________________________ Place of Birth ________________________
Day Month Year

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8. Religion: _________________________________________________________________

9. Gender: Male ____ Female ____ 10. Civil Status: Single ____ Married ___ Widow/er ___

11. If married, name and address of spouse: _______________________________________

________________________________________________________________________
______________________________________________ Tel. No. __________________
Fax No. _________________________ Email: ___________________
No. of children ___________________________________________________________

12. Name and address of person to contact in case of emergency: _______________________

___________________________________________________________________________
_______________________________________________ Tel. No. _______________
Fax No. _________________________ Email: _________________

13. Particulars of National Registration Identification Card: __________________________

_______________________________________________________________________

14. Passport Number _________________________________________________________

Date and Place of Issue: ___________________________________________________
Expiration Date: __________________________________________________________

B. PROFESSIONAL INFORMATION

I. Education

15. College/University attended (please start with the most recent):

Name of College /University and Country Year Major Diploma/

From To Subject/Field Degree
of Study

II. Experience and Background

16. Employment History (in chronological order, please use extra sheets if necessary):

Position Name of Institution/ Employer Year

From To

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17. Description of most recent job (Duties and Responsibilities):
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
__________________________________________________________________

18. Description of major area of interest (please use extra sheets if necessary)
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
__________________________________________________________________

19. Overseas conferences/seminars attended (please use extra sheets if necessary):

Name of Conference/Seminar Venue Dates

From To

20. Overseas courses attended including courses at SEAMEO Regional Centers/Projects (please use
extra sheets if necessary):

Name of Course Country/SEAMEO Regional Dates

Center/Project From To

21. Research carried out (please use extra sheets if necessary):

Title of Research Duration

From To

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22. Publications (please use extra sheets if necessary):

Title of Publication Year Published

23. Language proficiency (please indicate “Excellent”, “Good”, or “Fair”):

Language Reading Writing Speaking

Need for remedial English course (please check): Yes ______ No ______

What is your TOEFL or IELTS Score? __________________________________

Where did you take your TOEFL or IELTS? ______________________________

24. State briefly reason for pursuing the degree:

_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

25. Expected employment/job position upon completion of degree:

_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

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26. Have you applied for scholarship from other funding institutions? Yes _____ No _____

If yes, please answer numbers 27 and 28

If no, please skip numbers 27 and 28

27 Please enumerate names of funding or scholarship institutions:

Name of Organization/ Date of Application Status of Application/

Funding Institution Results

28. If you are offered a scholarship by any of the institutions listed in No. 27, would you still pursue
your application for SEARCA scholarship? Yes ______ No _______

_______________________ ________________________
Date Signature of Applicant