Professional Regulation Commission
APPLICATION FOR ACCREDITATION OF CPD PROGRAM
CPD Council for DENTISTRY
Part I. General Information
Name of Provider: Philippine Dental Association
Accreditation No.: 2009 – 001 Expiration Date: JAN 17, 2021
Contact Person: Dr. Stephen B. Almonte Designation: PDA President
Contact No.: Date of Application: AUGUST 17, 2019
Proposed Program:
/ Seminar Seminar/Workshop Residency Training Tours & Visits Others __________
Title of the Program:
Pasig Pateros Taguig Chapter –2ND Scientific Seminar
Date to be offered: OCTOBER 17, 2019 Time / Duration: 1:00pm – 6:00pm
Place / Venue: SM MEGAMALL MEGATRADE HALL No. of times program to be conducted: 1 time
Course Description:
A half day seminar of continuing dental education and for the improvement of knowledge and skills of Dentists with
topics on different fields of Dentistry using lectures and small group discussion.
Objectives:
-To provide and renew current knowledge on the fields of Orthodontics, Periodontics, Surgery and Prosthodontics
-To improve the knowledge of dentists in managing and preventing dental complications
-To improve patient safety in the dental environment with acquired knowledge
-To enhance knowledge on case selection in correlation with the said fields of dentistry
Target Participants / No.: Registration / Seminar Fee to be collected:
100-150 1200 Php
Part II. Acknowledgment
I HEREBY CERTIFY that the above information written by SUBSCRIBED AND SWORN to before me this _____
me are true and correct to the best of my knowledge and day of _______________ 20__ at
belief. I further authorize PRC and other agencies to ____________________, affiant exhibited to me
investigate the authenticity of all the documents presented. his/her valid government issued ID _______________
issued at _______________ on _______________.
Dr. Stephen B. Almonte .
Signature Over Printed Name
Phillipine Dental Association President _____________________________
Position (Notary Public)
.
Date
Part III. Action Taken
Standards & Inspection Division – CPD: Cash Division:
Processed by: _______________ Amount : ______________
Date : _______________ O.R.No./Date : ______________
Issued by : ______________
Reviewed by:
OIC, Standards and Inspection Divison
ACTION TAKEN BY THE CPD COUNCIL
Approved for _____ Credit Units Accreditation No. _______________
Disapproved
Deferred pending compliance ______________________________________
______________________________________________________________
______________________________
Chairperson
_____________________________ _____________________________
Member Member
Date____________________
SID-CPD-02
Rev. 01
July 26, 2016
Page 1 of 5
PROCEDURE FOR ACCREDITATION OF CPD PROGRAM
Step 1. Secure Application Form at the Standards and Inspection Division counter (Window 3) or download
at PRC website (www.prc.gov.ph).
Step 2. Fill-out Application Form and comply the required documents. Application should be filed in three (3)
copies: One (1) original signed and two (2) photo copies with the complete requirements with folder
and fastener. (Please provide one (1) set for receiving copy)
Step 3. Proceed to Standards and Inspection Division processing window 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) per offering of the
program.
Step 5. Submit Application Form with attached supporting documents and three (3) photocopies of official
receipt to the Standards and Inspection Division designated window.
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)
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 7 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.
SID-CPD-02
Rev. 01
July 26, 2016
Page 2 of 5
PROGRAM PLAN
11:30-12:30pm REGISTRATION
12:30-12:40pm Doxology, National Anthem, PPTC and PDA Hymn
12:40-12:55pm Welcome Address and Opening Remarks
Dr. Art Kevin De Leon
PPTC President
1:00pm Introduction of the 1st Guest Speaker
1:00-2:00pm 1st Guest Speaker
Academic Exchange
Awarding of Certificate of Appreciation
2:30pm Introduction of the 2nd Guest Speaker
2:30-3:30pm 2nd Guest Speaker
Academic Exchange
Awarding of Certificate of Appreciation
3:30-4:00pm BREAK
4:00pm Introduction of the 3rd Guest Speaker
4:00-5:00pm 3rd Guest Speaker
Academic Exchange
Awarding of Certificate of Appreciation
5:15-6:15pm 4th Guest Speaker
Academic Exchange
Awarding of Certificate of Appreciation
6:15pm Closing Remarks
Dr. Mina Pascual – Santos
PPTC President Elect
MASTER OF CEREMONIES
Allyn Ferrer, DMD – PPTC Past president
SID-CPD-02
Rev. 01
July 26, 2016
Page 3 of 5
BUDGET PROPOSAL
Venue Rental: inclusive of Sound System,Tables and Chairs 78000
SM Megatrade Meeting Room A and B
Food 15000
Props, Decorations, Tarpaulins, Plaques 5000
Honorarium (Awards) P3000/speaker
(P12000)
TOTAL P111000
SID-CPD-02
Rev. 01
July 26, 2016
Page 4 of 5
SID-CPD-02
Rev. 01
July 26, 2016
Page 5 of 5
