UPD-NIMBB F2F Submission Portal AY 2022-2023
This is the submission portal for participation in F2F activities this AY 2022-2023. All incoming BS MBB (i.e. juniors and seniors enrolled in an MBB major course), and all graduate students are prioritized for the first semester implementation of F2F activities.
Student Name
*
First Name
Last Name
Email
*
student@up.edu.ph
Year-level
*
BS MBB (2nd-Year Standing)
BS MBB (3rd-Year Standing)
BS MBB (4th-Year Standing)
MS MBB
PhD MBB
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Accommodation and Mobility
Lodging Arrangement
*
Private Accommodation
UPD Dormitories
Other
Where will you stay while participating in F2F?
*
Barangay/Area, City (For example: Brgy. Krus na Ligas, Quezon City)
Transportation Arrangement
*
Own Vehicle
Public Transportation
Ride Hailing Apps (i.e. Grab, Angkas)
Other
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Laboratory/PI Affiliations
We will be organizing an NIMBB Research Laboratory Open House sometime in September 2022 for students (Undergraduate and Graduate students) who have yet to find a research lab. We recommend all incoming 3rd year students to find a research lab within this semester.
Are you currently a member of a laboratory?
*
Yes
No
Adviser
*
Please Select
Cynthia P. Saloma, PhD
Denise Mirano-Bascos, PhD
Eloise Prieto-Vasquez, PhD
Jose Enrico H. Lazaro, PhD
Jose Ramon Planta, PhD
Ma. Anita M. Bautista, PhD
Neil Andrew D. Bascos, PhD
Pia D. Bagamasbad, PhD
Reynaldo L. Garcia, PhD
Ron Leonard Dy, PhD
Vermando M. Aquino, PhD
Wilberto D. Monotilla, PhD
If you have yet to find an adviser, whose laboratory are you interested to be a part of?
*
Please Select
Cynthia P. Saloma, PhD
Denise Mirano-Bascos, PhD
Eloise Prieto-Vasquez, PhD
Jose Enrico H. Lazaro, PhD
Jose Ramon Planta, PhD
Ma. Anita M. Bautista, PhD
Neil Andrew D. Bascos, PhD
Pia D. Bagamasbad, PhD
Reynaldo L. Garcia, PhD
Ron Leonard Dy, PhD
Vermando M. Aquino, PhD
Wilberto D. Monotilla, PhD
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Emergency Contact
Contact Name
*
First Name
Last Name
Mobile Number
*
Please enter a valid phone number.
Format: +63 000 0000000.
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F2F Requirements
Based on OVPAA Memorandum No. 2022-123, all students participating in F2F must be fully vaccinated and recommended to have booster shots.
Are you vaccinated against SARS-CoV-2?
*
Yes, I am fully vaccinated and with booster shots.
Yes, I am fully vaccinated.
Yes, I am vaccinated but only with the first dose.
No, I am waiting to be vaccinated.
I do not want to be vaccinated.
First Dose (Vaccine Brand)
*
Please Select
Pfizer/BioNTech
Moderna
Sinovac
AstraZenica
Gamaleya Sputnik
Gamaleya Sputnik Light
J&J
Sinopharm
Others
First Dose (Vaccination Date)
*
-
Month
-
Day
Year
Date
Second Dose (Vaccine Brand)
Please Select
Pfizer/BioNTech
Moderna
Sinovac
AstraZenica
Gamaleya Sputnik
Gamaleya Sputnik Light
J&J
Sinopharm
Others
Second Dose (Vaccination Date)
-
Month
-
Day
Year
Date
Booster (Vaccine Brand)
*
Please Select
Pfizer/BioNTech
Moderna
Sinovac
AstraZenica
Gamaleya Sputnik
Gamaleya Sputnik Light
J&J
Sinopharm
Others
Booster Dose (Vaccination Date)
*
-
Month
-
Day
Year
Date
Vaccination Card
*
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Confidentiality Agreement
In submitting this form, I agree to my details being solely used for the preparation and in compliance of NIMBB for enforce face-to-face activities. The information will only be accessed by necessary NIMBB staffs, health liaisons, and faculty. I understand my data will be held securely and will not be distributed to third parties. I have a right to change or access my information. I understand that when this information is no longer required for this purpose, official university procedure will be followed to dispose of my data.
*
Yes
No
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