REQUEST FOR INCENTIVE OF RESEARCH OUTPUT

THE UNDERSIGNED HEREBY REQUEST FOR INCENTIVE BE APPLIED. / (The following is to be filled in by the University Research Office)
Application No.:TSU-URO-SF-04
Filing Date:
Date of Receipt:
(1) APPLICANT’S INFORMATION
Full Name:
Department/Office/College:
Office Contact Number:
Contact Number:
E-mail Address:
(2) KIND OF RESEARCH OUTPUT (PLEASE CHECK ✓)
International Publication National Publication
International Oral Presentation National Oral Presentation
Terminal Incentives Citations
Winners in Research Competitions  Cash Prizes for Oral Presentation in the UniversityIn-House
Review of Researches
NOTE:
  • For PUBLICATION, proceed to 3A
  • For PRESENTATION, proceed to 3B
  • For TERMINAL INCENTIVE, proceed to 3C
  • For CITATION, proceed to 3D
  • For WINNERS IN COMPETITIONS and CASH PRIZE for ORAL PRESENTATION IN THE UNIVERSITY
IN-HOUSE REVIEW, proceed to 3E
(3) DETAILS OF RESEARCH OUTPUT
  1. RESEARCH PUBLICATION
Title of Article
Name of Journal
ISSN/Volume/Number
Date of Publication
Editor
Publisher/Address
Number of Pages
Indexing Agency
Amount of Incentive / ₧ ______
(Attach copy of journal or the article including cover page, copyright page, editorial board and table of contents of the journal)
  1. RESEARCH PRESENTATION
Title of Paper
Title of Conference/ Seminar
Sponsoring Agency
Date
Place
Amount of Incentive / ₧ ______
(Attach copy of the paper, invitation to the presentation, program of the conference, certificate of appearance, certificate of recognition/participation and travel order)
  1. TERMINAL INCENTIVES
Title of Paper
Name of Authors and co-Authors:
Date of Completion
Final Evaluation Rating:
(to be filled by URO)
Amount of Incentive / ₧ ______
(Attach copy of the revised paper and college level evaluation)
  1. CITATION
Title of Research
Title of the Citing Article/Book
Author/s of the Article/Book
Citing Journal/Book
ISSN/Volume/Number
Date of Publication
Editor
Category of the Citing Journal/Books / SCOPUS, Thomson Reuters (ISI, ISSI), Proquest, Elsevier
and CHED Accredited Journals Category A and B
Book by International Authors (does not include self-citation)
Google Scholar Indexing and all other International Refereed Journals
Amount of Incentive / ₧______
(Attach copy of the Citing Article)
  1. WINNERS IN RESEARCH COMPETITION/ORAL PRESENTATION IN THE UNIVERSITY IN-HOUSE REVIEW
Title of Research
 Research Competition /  In-House Review
Name of Competition / Category /  Science, Technology, Engineering and Mathematics
 Social Science and Education
Competition Level /  International  National Regional / Place /  First
 Second
 Third
Place / First  Third
 Second  Best Paper
Amount of Incentive / ₧ ______
(Attach copy of the paper, invitation to the presentation, program of the event, certificate of appearance, certificate of recognition and travel order if applicable)
(4) CERTIFICATION
I hereby certify that the information given are true and correct.
_ _______ ____________
Signature over Printed Name of the Applicant Date
(5)ENDORSEMENT (to be accomplished by URO)
______
Director, URO Date
(6) RECOMMENDING APPROVAL(to be accomplishedby theoffices of VP RES and VP Finance & Administration)
______Vice President, RES Date Vice President, Admin. & Finance Date
(7) AVAILABILITY OF FUNDS (to be accomplishedby the Budget Management Office)
____________
Budget Officer Date
(8) APPROVED (to be accomplished by the Office of the President)
____________
President Date

Received approved request:

______

Signature over Printed Name of URO Representative Position/Designation Date

Form No.: TSU-URO-SF-04 | Revision No.: 00 | Effective Date: June 28, 2016 / Page 1 of 2