PHILIPPINE INSTITUTE OF CIVIL ENGINEERS, INC.

Application for Elevation of PICE Members to Specialist Category

SD Form 1

( ) TYPE I (Recipients of Certificate of Recognition by the Professional Regulation Commission)

( ) TYPE II (New Applicants)
 GEOTECHNICAL ENGINEERING (GtE)  PROJECT MANAGEMENT & CONSTRUCTION ENGINEERING (PMCE) Application Code: ________
STRUCTURAL ENGINEERING (StE)  TRANSPORTATION ENGINEERING (TrE)  WATER ENGINEERING (WE)

Name ___________________________________________/_________ /__________________________________________________________________

Given M.I. Surname

PRC Reg. No. ______________________________ Date Reg. __________________________ Date of Birth __________________________________
Educational Attainment  BSCE School ________________________________________________________________ Year ________________
MS in ________________________ School ________________________________________________________________ Year _________________
 PhD in ______________________ School ________________________________________________________________ Year ________________
PICE Chapter ________________________ Date of Regular Membership in PICE ______________ Fellow  LM Date approved:_______________
Home Address ________________________________________________________________________________________________________________
Tel. No. __________________________ Fax No. ______________________ Mobile No. _____________________ E-mail ________________________
Office Name/ Address __________________________________________________________________________________________________________
Position _________________________ Tel. No. ______________________ Fax No. __________________ E-mail _____________________________
Membership
Previous in Other
Specialist Professional Organizations: ___________________________________________________________________________________
Certificates
Specialty Division No Date of Conferment PICE SECRETARIAT
_____________________________ ______ ___________________ Received by: _______________________________ Date: _____________
_____________________________ ______ ___________________ Life Membership Validated: __________ LM No. ______ Date: _________
_____________________________ ______ ___________________ BOX 1 - Requirements: Payment of
TYPE I Accreditation Fee
REQUIREMENTS FOR ACCREDITATION OF SPECIALTY DIVISION Amount: ____________
 PRC Certificate of Recognition
TYPE I (__)– NO EVALUATION.  Notarized Curriculum Vitae with Photo
PICE Members who have been awarded a Certificate of Recognition by the Professional Regulation TYPE II Date:_______________
Commission for the specific area of specialization prior to year 2000.  Notarized Curriculum Vitae with Photo OR No. _____________
 Description of Practice following Form S2
Specialization:
 Certificates (authenticated)
_____________________________________________________________________________________
 Others_________________________ Validated by:_________________________
Validated by:
Date Issued : _____________________________________Resolution No. _______________________ Endorsement of Chapter – Action of the
__________
(Submit any of the following) Secretariat:
Submitted ( ) enclose Certified True Copy of Certificate issued by PRC and ___ Chapter Board Resolution
( ) most recent notarized curriculum vitae with photo. ___ Minutes of Chapter Board Meeting
TYPE II (__) – NEW APPLICANTS ___ Endorsement letter signed by the Chapter
Compliance with the Criteria - New requirements for accreditation of specialist member: President/attested by the Chapter Secretary
1. All applicants must be PICE life members.
2. No Examination - Applicants with at least 15 years experience in, or with a doctoral degree in the
area of specialization are not required to take a written examination but will be subject to an Action of the PICE Specialty Division: ___________________________
interview by the concerned Committee of the Specialty Division.  For Examination  For Interview
3. With examination  For Evaluation
3.1 Applicants with at least 10 years experience in the area of Specialization may take the Date
examination; OR SD1 ______________________: _________________________ ____________
3.2 Applicants with at least five (5) years rated continuous active practice in the area of
specialization; AND at least 80 CPD (Continuing Professional Development) units, provided SD2 ______________________: _________________________ ____________
that not more than 30 CPD units that have been obtained before year 2000 can be credited; OR
3.3 Applicants with a master’s degree in and at least three (3) years active practice in the area of SD3 ______________________: _________________________ ____________
specialization
 The examination for accreditation as a specialist member will be guided by the Design Manual and/ or SD4 ______________________: _________________________ ____________
Syllabus to be issued as reference by the five (5) Specialty Divisions as well as seminars to be
attended by the applicants. SD5 ______________________: _________________________ ____________
 AND: Interview at the discretion of the concerned specialty division;
4. Applicants must submit duly notarized curriculum vitae. Interview: ______________________________________________________ ______________
5. The PICE National Secretariat shall receive all applications for accreditation and is tasked to verify
the authenticity of documents and information submitted. Recommending Approval: __________________________________ ______Date:______________
Chair, Specialty Division
Submit: Examination _____________________________________________________________________
1. Detailed description of practice in the specific area of specialization. Enumerate the dates/periods
of engagement and provide a list of projects participated in, with corresponding description of
Recommending Approval: _________________________________________Date:______________
technical service(s) rendered. (FOLLOW FORMAT ON FORM S2) Chair, Inter-Specialty Group
2. Proof of engagement and certified true copy of Certifications
3. Other requirements listed on Box 1. Action of the National Board of Directors:

Approved by: __________________________________________________________

National President
Submitted by:
_________________________________________________________________________________________ Attested by:___________________________________________________________
National Secretary
Printed Name and Signature
Date of Board Meeting: __________________________________________________
Date: _________________________________________________________________________________ AWARD
PICE Certificate No. _______________ Year-Specialty Code No.________________
Date of Examination/Interview: _____________________________________________________________

Note: Please attach a photo with this form. Submit a separate application and documents for different specialization. Please enclose
your one-time accreditation fee of Php 1,000 per application. All checks must be payable to PICE.

PICE-OPN-FM-03-01/Rev.00/Eff. Date : June 2, 2014 SD Form S1-Revised May 6, 2011