ANNEX - Department of Education

ANNEX

ANNEX A: QAD Frontline Services Documentary

Requirements

1

PROCESSING SHEET FOR APPLICATION OF PRIVATE SCHOOLS FOR APPROVAL OF SCHEDULE OF FEES

Private Kindergarten/Elementary/Junior High School/Senior High School Pursuant to DepEd Order No. 88, s. 2010; DO No. 11, s. 2011; Regional Memorandum No. 134, s. 2018

Registered Name of School: ___________________________________ SEC DTI Complete Address of School: __________________________Email Add:_________________ Name of School Administrator __________________________Contact Nos.______________ Course Application: _____ Kindergarten _____ Elementary (Grades 1 to 6) _____ Junior High School (Grades 7 to 10) _____ Senior High School (Grades 11 & 12) School Year:__________________________Date Submitted to ROV:___________________

No.

Name of Required Documents

Available (√)

Not Available

(x)

Remarks

1 Indorsement Letter from SDO indicating among others, the School’s Securities and Exchange Commission (SEC) registered name and address.

2 Letter of Intent addressed to the Regional Director signed by the School Head/Administrator, indicating among others the school’s intention for such schedule of fees/Tuition and Other School Fees (TOSF).

3 Notarized Certificate of Authenticity and Veracity of documents.

4 Statement under oath by the School Head/Administrator of the itemized proposed rates of tuition and other charges.

5 Proof of the consultation conducted with the duly organized student government and the parents of the pupils/students (Original Copy of the Minutes of the Meeting with the Names and signature of the attendees) on the proposed schedule of fees/TOSF.

6 Tabular presentation of Schedule of Tuition and Other School Fees (TOSF) in Pesos (Php) per grade or year level. (Other School Fees must be itemized & should be attached to the computed schedule of TOSF). This shall be reviewed by the SEPS or EPS II of SM&ME. The reviewed Schedule of TOSF shall be forwarded to the RO-QAD.

7 Certification under oath that 70% of the tuition and other school fees (TOSF) or charges shall be allocated for payment of salaries, wages, allowances and other benefits of the members of the faculty and all other employees of the school concerned and the balance for institutional development, student assistance and extension services and return of investment.

8 Photocopy of the Government Permit/Government Recognition.

9 Payroll on Teachers Salary Subsidy (TSS) of Education Service Contracting (ESC) Scheme

DOCUMENTARY REQUIREMENTS

2

Participating School with a photocopy of PRC License (for GASTPE recipient-schools).

10 List and Profile of Staff/Faculty Members by subject area/course/level

11 Latest Certificate of Corporate Filing and Information from Securities and Exchange Commission (SEC) or Department of Trade and Industry (DTI).

Findings/Recommendations: _______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

Evaluated by: Date of Evaluation: ________________________________ _______________________ QAD EPS (Name and Signature) Noted by: ____________________ Chief ES, QAD

1

PROCESSING SHEET FOR APPLICATION OF PRIVATE SCHOOLS FOR

APPROVAL OF WITH INCREASE IN TUITION AND OTHER SCHOOL FEES (TOSF)

Private Kindergarten/Elementary/Junior High School/Senior High School Pursuant to DO No. 88, s. 2010; DO No. 11, s. 2011; Regional Memorandum No. 134, s. 2018

Registered Name of School: ___________________________________ SEC DTI Complete Address of School: __________________________Email Add:_________________ Name of School Administrator: _________________________Contact Nos._______________ Course Application: _____ Pre-Elementary (Kindergarten) _____ Elementary (Grades 1 to 6) _____ Junior High School (Grades 7 to 10) _____ Senior High School (Grades 11 & 12)

SHS CATEGORY: _____A-SUC

_____B-TESDA _____C-LUC _____D-CHED

School Year :__________________________Date Submitted to ROV:___________________

No.


Available (√)

Not Available

(x)

Remarks

1 Indorsement Letter from SDO indicating among others, the School’s Securities and Exchange Commission (SEC/DTI/CHED/TESDA) registered name and address.(Mayor’s Permit for LUC/SUC

2 Letter of Intent addressed to the Regional Director signed by the School Head/Administrator, indicating among others the school’s intention for such increase or schedule of fees or signifying no intention to increase the Tuition and Other School Fees (TOSF).

3 Notarized Certificate of Authenticity and Veracity of Documents

4 Statement under oath by the School Head/Administrator of the itemized current rates of tuition and other charges and the corresponding itemized proposed charges thereon as well as the new fees or charges proposed to be imposed and of the proposed allocation of the incremental proceeds.

5 Latest Audited Financial Statements of the school. 6 Copy of the latest Income Tax Returns filed with the

Bureau of Internal Revenue (BIR).

7 Proof of the consultation conducted with the duly organized student government and the parents of the pupils/students (Minutes of the Meeting with the Names and signature of the attendees) stating the reason/s of increase.


2

8 Comparative Schedule of Tuition and Other School Fees (TOSF) for current School Year (SY) with that of the previous SY indicating in both in Peso (Php) and Percentage (%) the forms of increase. This should be done both by the school With increase and With No increase. (Other School Fees must be itemized & should be attached to the comparative schedule of TOSF). This shall be reviewed by the SEPS or EPS II of SM&ME. The reviewed Schedule of TOSF shall be forwarded to the RO-QAD.

9 Certification under oath that 70% of the tuition and other school fees (TOSF) or charges shall be allocated for payment of salaries, wages, allowances and other benefits of the members of the faculty and all other employees of the school concerned and the balance for institutional development, student assistance and extension services and return of investment.

10 Photocopy of the approved Tuition and Other School Fees (TOSF) of previous school year or latest noted/approved fees.

11 Photocopy of the Government Permit/Government Recognition

12 Payroll on Teachers Salary Subsidy (TSS) of Education Service Contracting (ESC) Scheme Participating School with a photocopy of PRC License (for GASTPE recipient-schools).

13 List and Profile of Staff/Faculty Members by subject area/course/level

14 Pictures/Photos of School Facilities needing improvement

15 Latest Certificate of Corporate Filing and Information from Securities and Exchange Commission (SEC) or Department of Trade and Industry (DTI).

16 Annual Accomplishment Report of the previous year to determine the performance of the school


_______________________________________________________________________________

_______________________________________________________________________________

Evaluated by: Date of Evaluation: ________________________________ _______________________ QAD EPS (Name and Signature) Noted by: _______________________ Chief ES, QAD

1

PROCESSING SHEET FOR APPLICATION OF PRIVATE SCHOOLS FOR APPROVAL OF NO INCREASE IN TUITION

AND OTHER SCHOOL FEES (TOSF) Private Pre-Elementary (Kindergarten)/Elementary/Junior High School/Senior High School

Pursuant to DO 88, s. 2010; DO 11, s. 2011; Regional Memorandum No. 134, s. 2018 Registered Name of School: __________________________________SEC DTI Complete Address of School: __________________________Email Add :_________________ Name of School Administrator __________________________Contact Nos.______________ Course Application: _____ Pre-Elementary (Kindergarten) _____ Elementary (Grades 1 to 6) _____ Junior High School (Grades 7 to 10) _____ Senior High School (Grades 11 & 12)

SHS CATEGORY: _____A-SUC

_____B-TESDA _____C-LUC _____D-CHED

School Year:__________________________ Date Submitted to ROV:___________________

No.


Available (√)

Not Available

(x)

Remarks

1 Indorsement Letter from SDO indicating among others, the School’s Securities and Exchange Commission (SEC/DTI/CHED/TESDA) registered name and address.(Mayor’s Permit for LUC/SUC)

2 Letter of Intent addressed to the Regional Director signed by the School Head/Administrator, indicating among others the school’s intention not to increase the Tuition and Other School Fees (TOSF).

3 Comparative Schedule of Tuition and Other School Fees (TOSF) for current School Year (SY) with that of the previous School Year indicating in both in Peso (Php) and Percentage (%) the forms of increase. This should be done both by the school With increase and No increase. (Other School Fees must be itemized & should be attached to the comparative schedule of TOSF). This shall be reviewed by the SEPS or EPS II of SM&ME. The reviewed Schedule of TOSF shall be forwarded to the RO-QAD.

4 Photocopy of the Government Permit/Government Recognition.

5 Latest Certificate of Corporate Filing and Information from Securities and Exchange Commission (SEC) or Department of Trade and Industry (DTI)/CHED/SUC/LUC/TESDA.

6 Photocopy of the approved Tuition and Other School Fees (TOSF) of previous school year or latest noted/approved TOSF (with breakdown of fees attached.


2

Notes:

a. Please indicate N/A, if not applicable b. Kindly submit all the lacking documents on or before_______________ c. Documents to be submitted must be two (2) sets, placed in separate folders, arranged

following the sequence above and labelled appropriately. d. To facilitate evaluation, please do not include other documents not listed above.


_______________________________________________________________________________

_______________________________________________________________________________

Evaluated by: Date of Evaluation: ________________________________ _______________________ QAD EPS (Name and Signature)

Noted by: ____________________ Chief ES, QAD

1

PROCESSING SHEET FOR APPLICATION OF PRIVATE SCHOOLS FOR GOVERNMENT RECOGNITION

Private Kindergarten, Elementary, Junior High School Pursuant to DO 88, s. 2010, DO 11, s. 2011, RM 59, s. 2016

Registered Name of School: ___________________________________ SEC DTI Complete Address of School: __________________________ Email Add:_______________ Name of School Administrator __________________________Contact Nos.______________ Course Application: _____ Pre-Elementary (Kindergarten) _____ Elementary (Grades 1 to 6) _____ Junior High School (Grades 7 to 10) School Year :__________________________Date Submitted to ROV:___________________

No.


Available (√)

Not Available

(x)

Remarks

1 Indorsement Letter from SDO indicating among others, the School’s Securities and Exchange Commission (SEC) registered name and address.

2 Letter of Intent addressed to the Regional Director signed by the School Head/Administrator tru the SDS, indicating among others the school’s intention to apply for Government Recognition (indicating the course applied (course/grade/level)

3 Notarized Certificate of Authenticity and Veracity of documents signed by the School Head/Administrator

4 Ocular/Site Inspection and Document Evaluation Report prepared by the Division Supervisor and/or SEPS-M&E In-Charge of Private School signed by the Chief of the School Governance and Operation Division (SGOD) using the Processing Sheet. (Accomplished Processing Sheet must be included in the Documents submitted to be reviewed by the QAD EPS In-Charge).

5 Copy of the latest permit 6 Copy of Accomplishment Report/Achievements for

the past three (3) school years

7 Copy of the SEC Registration Certificate/DTI Certificate

8 Copy of Transfer Certificate of Title (TCT) in the name of the school or incorporator duly signed by the Municipal/City Assessor Officer or Notarized Copy of Deed of Donation/Usufruct/Perpetual Use (maximum of 50 years) – Institutional/Educational

9 Copy of Transfer Certificate of Occupancy (Institutional/Educational) -for newly built building/s Note: Clearance from the City/Municipal Engineer for the safety of the occupants

10 Official Receipt (O.R) for application and inspection fee (Pre-Elem, Elem. And Junior High School)

11 Inspection Fee and Application Fees Receipt (P2,020.00 + P2,020.00)

12 All facility requirements were compiled/maintained (Pls. see separate Processing Sheet on the On-Site Ocular Inspection Report)


2

Course/Grade Level Official Receipt No. Date of Issuance

a. Kindergarten b. Elementary c. Junior High School


_______________________________________________________________________________

_______________________________________________________________________________

Evaluated by: Date of Evaluation: Conforme: ____________________________ _______________ ________________________ (Name and Signature of Evaluator) School Head/Administrator Noted: _____________________________ Chief ES

PROCESSING SHEET FOR APPLICATIONS FOR ISSUANCE OF SPECIAL ORDER (SO) Pursuant to DepEd Order No.10 s. 2018 and Regional Memorandum No. 46, s. 2018

Registered Name of School: ________________________________________________ Complete Address of School:_______________________________________________ Name of School Administrator:___________________________Contact No.__________ Senior HS Track/Strand and Specialization: Track:_______________________________ _________________________________________________________________________ Strand:____________________Specialization:_____________________________ School Year:_________Total No. of Students:______Date Submitted to ROV:_________

No. Name of Required Documents Available

(√)

Not Available

(x)

Remarks

1 Indorsement Letter from the Schools Division Superintendent

2 Letter of intent addressed to the RD through channel 3 Attestation of Documents per school signed by the

SGOD Chief and Schools Division Superintendent

4 Masterlist of Grade 12 learners qualified to graduate per section: track, strand, specialization (spreadsheet submitted by the school)

5 SF 10 (Permanent Record) 6 Birth Certificate (NSO/PSA) 7 Approved Provisional Permit relative to specific

school year of SO application

Generated SO Form from the SO creator software in four (4) copies with correct pagination.

x 8.5 by 13 size paper using four (4) colors (Ivory, Yellow, Green and Pink)


_______________________________________________________________________________

Evaluated by: Date of Evaluation: _________________________ _______________________ Evaluator (Signature above printed name)

Noted by:

__________________________ Chief ES, QAD


1

PROCESSING SHEET FOR APPLICATION OF GOVERNMENT PERMIT TO OPEN/ESTABLISH A PRIVATE SCHOOL

Kindergarten/Elementary/Junior High School Pursuant to DepEd Order No. 88, s. 2010 & Regional Memorandum No. 59, s. 2016

Registered Name of School: ___________________________________ SEC DTI Complete Address of School: __________________________ Email Add:_______________ Name of School Administrator __________________________Contact Nos.______________ Course Application: _____ Kindergarten _____ Elementary (Grades 1 to 6) _____ Junior High School (Grades 7 to 10) School Year :__________________________Date Submitted to ROV:___________________

No. Name of Required Documents

Complied (√)

Not Complied

(x)

Remarks

1 Indorsement letter from the SDO indicating among others, the School’s Securities and Exchange Commission (SEC)/Department of Trade and Industry (DTI) registered name and address.

2 Letter of Intent/Transmittal (including specific school year of opening) addressed to the Regional Director through the Schools Division Superintendent

3 Board Resolution to open a new school/course/grade/year level certified by the Board Secretary for SEC registered schools

4 Notarized Certificate of Authenticity and Veracity signed by the School Head/Administrator

5 Notarized Feasibility Study covering the following factors/items:

x Purpose and objectives of proposed school or course;

x Availability and adequacy of school site and building, including documents of ownership thereof, location plan, development plan, pictures, or architect’s plan of building, if the same is still to be constructed;

x Itemized cost of the project covering the entire course in terms of site, site development, school building and quarters, classroom equipment and facilities, library, salaries of faculty, and staff and maintenance;

x Financial capacity of applicant, including his resources to provide the requirements for the entire course and to support its operation from year without depending solely on students’ fees (Attach a Copy of BIR Income and Financial Statement of the owner/incorporators

x Proposed faculty line-up and administrative and supervisory staff together with their individual Transcript of Records and

DOCUMENTARY REQUIREMENTS AND REQUIRED FACILITIES

2

evidence of willingness to join the school; and

x Need or demand for establishment of the school or operation of the course in the locality. If the course is already being offered in the same town or city, there must be an evidence of the following factors:

x Distance of the applicant school to the existing school

x Enrolment in the existing school x Number of students in the same locality

enrolled in schools other than in the existing school;

x Number of prospective students of applicant-school; and

x Facilities, standards, and supportive provisions for effective instruction and quality education

6 Articles of Incorporation and by-Laws 7 Certificate of Registration with the DTI (for sole

ownership/single proprietorship

8 Securities and Exchange Commission (SEC) Registration Certificate of the Lease Contract, if not owned

9 SEC Certification 10 Copy of Transfer Certificate of Title of the school

site / usufruct / proof of ownership of the school site / perpetual use

11 Document/Certification of the actual lot area/floor area of building/s and classrooms duly signed by the municipal or city engineer

12 Clearance/Permit from the Municipal/City DRRMO stating that the proposed school site is not a high risk area

13 Campus Development and landscaping plan duly signed by proper authority

15

Certificate of Occupancy of school buildings duly signed by proper authority

16 Latest Fire Inspection Certificate 17 Proposed Budget for the succeeding school year

approved by the school administrator/Board of Trustees/Directors

19 Proposed Curriculum in accordance with DepEd standards and requirements validated by the Curriculum Implementation Division (CID)

20 Schedule of Tuition and Other School Fees (TOSF) subject to approval of DepEd Regional Director

21 List of School Administrators, their educational Qualifications, school credentials (TOR’s), certificate of trainings on school administration, and expected salaries

22 List of Teaching/Academic Staff their educational qualifications, school credentials (TOR’s), subject assignments/salaries, other benefits, valid contracts/appointments, proof of eligibility, PRC license

3

23 List of Non-Teaching/Non-Academic Staff, their educational qualifications, school credentials

24 Copy of Retirement Plan (SSS, Philhealth, Pag-IBIG)

25 List and pictures with label of essential ancillary services

x Library and Library Holdings x guidance office x faculty room x medical and dental facilities x canteen x sports facilities and equipment x gender-sensitive comfort rooms and

lavatories x ramp for PWDs x others

26 List and Pictures of x school buildings x classrooms x standard flag pole x laboratories x water source and facilities x electrical facilities x school signage

27 x School Anti-Bullying Policy x Child Protection Policy x Proposed Child Protection Committee

28 Student Handbook (Draft for approval and enhancement of stakeholders)

29 Tentative Calendar of Activities for the School Year

30 Class Program per Grade/Year level (workload, no. of hrs, no. of learners in classroom/s)

31 Copy of Latest Updated/Insurance Certificate 32 Projected tentative enrollment 33 Ocular Inspection Report x Evaluation: Summary of findings, strong

points, and deficiencies noted

x Recommendations strictly based on findings during the visit and existing standards and regulations

34 Inspection Fee (P 2,020.00) and Application Fees Receipts per level (P 2,020.00). Please encircle below the course applied for:

a.) Pre-Elem OR No. ____ Date of Issuance _____ b.) Elementary OR No. ____ Date of Issuance _____ c.) Junior HS OR No. ____ Date of Issuance _____

4


_______________________________________________________________________________

_______________________________________________________________________________

Validated by: Date of Validation: Conforme: ____________________________ _______________ ________________________ (Name and Signature of Validator) School Head/Administrator Noted: ___________________________ Chief ES

1

PROCESSING SHEET FOR APPLICATION FOR RENEWAL OF GOVERNMENT PERMIT

Private Kindergarten/Elementary/Junior High School/Senior High School Pursuant to DepEd order No. 88, s. 2010 & Regional Memorandum No. 59, s. 2016

Registered Name of School: ___________________________________ SEC DTI Complete Address of School: __________________________Email Add: _______________ Name of School Administrator __________________________Contact Nos._____________ Course Application: _____ Kindergarten _____ Elementary (Specify Grade Levels _______________) _____ Junior High School (Specify Grade Levels _____________) _____ Senior High School (Specify Grade Levels _____________) School Year: __________________________ Date Submitted to ROV: ___________________

No.


Available

(√)

Not Available

(x)

Remarks

1 Indorsement letter from Schools Division Superintendent

2 Letter of Intent (Application Letter stating the nature of Government Permit being applied for)

3 Certification of Authenticity and Veracity of Documents from Schools Division Superintendent

4 Ocular Inspection/Progress Monitoring Report by the In-Charge of Private Schools signed by the Chief of Schools Governance and Operations Division (SGOD)

5 Documentary Evaluation Report >Refer to PS-QAD-07-Processing Sheet for Ocular Inspection/Validation of Schools) >Qualitative Evaluation Processing Sheet (QEPS) for SHS only

6 Inspection Fee and Application Fees Receipt (P2,020.00). Please encircle below the course applied for. 1) KINDERGARTEN O.R. No.______Date of Issuance______ 2) ELEMENTARY O.R. No.______Date of Issuance______ 3) JUNIOR HS O.R. No.______Date of Issuance______ 4) SENIOR HS O.R. No. _____ Date of Issuance _____


2


_______________________________________________________________________________

_______________________________________________________________________________

Notes:

1. Please indicate N/A, if not applicable 2. Kindly submit all the lacking documents on or before_______________ 3. Documents to be submitted must be two (2) sets, placed in separate folders, arranged

following the sequence above and labelled appropriately. 4. To facilitate evaluation, please do not include other documents not listed above.

Validated by: Date of Validation: ____________________________ _______________ (Name and Signature of Evaluator)

Noted:

________________________ Chief ES

1

PROCESSING SHEET FOR APPLICATION FOR CONVERSION OF EXISTING ELEMENTARY AND JUNIOR HIGH SCHOOL INTO A STAND-ALONE SENIOR

HIGH SCHOOL Pursuant to DepEd Order No. 51, s. 2015.

Registered Name of School: ______________________________School ID: _________ Complete Address of School:_______________________________________________ Name of School Administrator___________________________Contact No.__________ Course Application:________________________________________________________ School Year:____________________________Date Submitted to ROV:______________

No.


Available (√)

Not Available

(x)

Remarks

1 Indorsement letter 2 Certification of DepEd School Identification (ID)

prepared by the Planning Unit

3 Letter-request for Implementation of the SHS program addressed to the Schools Division superintendent (SDS)

4 Certification signed by the SDS stating that no public SHS is offering the same SHS track within the catchment area ___a. Justification signed by the SDS, in case will offer the same SHS track

5 Implementation Plan, for SHS program covering five (5) years to including among others: ___a. Current and projected enrollment for (5) years, by grade level; ___b. Proposed budgetary requirements for Personnel Services, Maintenance and other Operating Expenses, and Capital Outlay. ___c. Operational Plan regarding curriculum and Instructional Supervision of the proposed SHS. ___d. School Site Development Plan to include proposed school buildings, as needed.

6 Certification signed by the School Head, duly attested by the SDS on the excess classrooms, tables, chairs and other resources to be used in the implementation of SHS program.

7 Inventory of learning resources prepared by the Property Custodian as validated by the Schools Division Office

8 Updated Personnel Services Itemization and Plantilla of Personnel of the concerned school.

9 Updated Status Report with regards to the existing crucial resources.

10 .Map, preferably drawn to scale, showing the vacant lot where the proposed SHS classrooms/school building are/will be constructed, duly certified by the Municipal/City Engineer.


2

11 List of prospective enrollees in SHS per track and strand, indicating their names, Learner Reference Number (LRN), where applicable, age, addresses, school names, DepEd School ID Numbers where they are currently or previously enrolled ___a. Justification signed by the SDS, in case the required minimum enrolment and/or number of tracks are not satisfied.

12 List and types of establishment and industries in the community, as attested to by the Department of Trade and Industry, Department of Labor and Employment or the Municipal Planning Officer.

13 Certification from the SDS that the track (s) and strand (s) to be offered are aligned with the Local Development Plans, as evident in the list provided by the Municipal/City Mayor , and are decided upon by the Regional Director, SDS, Division Planning Officer and School Head concerned.

14 Result of internal assessment or survey done with the prospective enrollees.

15 List of tracks and strands to be offered, duly signed by the RD or SDS, Planning Officer and School Head.

16 MOA executed between the SDS and the partner entity enumerating the respective roles of both parties.

17 Immersion Deployment Plan. 18 Certification duly signed by the SDS on the

compliance to the following conditions: ___a. Learners are not denied access to elementary and JHS education as the result of the conversion ___b. Prior consultation with both internal and external stakeholders is conducted for the purpose by the SDS and School Head of the concerned elementary or JHS ___c. Health and safety of any learner is not compromised as a result of the conversion and subsequent transfer of elementary and/ or JHS learners, taking into consideration the distance to be travelled to and from the new school site. ___d. Affected school personnel shall not be displaced and demoted, and shall be transferred to the nearest school were the services are needed.

19 Sangguniang Bayan/Panglungsod Resolution signifying the Local Government Unit support to the conversion of the school into an SHS, duly approved by the Municipal/City Mayor.

3

Notes: a. Please indicate N/A, if not applicable b. Kindly submit all the lacking documents on or before_______________ c. Documents to be submitted must be two (2) sets, placed in separate folders,

arranged following the sequence above and labelled appropriately. d. To facilitate evaluation, please do not include other documents not listed above.


_______________________________________________________________________________

_______________________________________________________________________________

Evaluated by: Date of Evaluation: ________________________________ _______________________ QAD EPS (Name and Signature) Noted by: ______________________ Chief ES, QAD

1

PROCESSING SHEET FOR APPLICATION FOR CONVERSION OF SCHOOLS

Elementary/Secondary School (s) into an Integrated School Pursuant to DepEd Order No. 40, s. 2014.

(Item A.4b pp 9-11; B.4.b pp 20; Annex 4-C.b pp 44-45; D-4b pp 166-171) Registered Name of School: ________________________________________________ Complete Address of School:_______________________________________________ Name of School Administrator___________________________Contact No.__________ Course Application:________________________________________________________ School Year:____________________________Date Submitted to ROV:______________

No.


Available (√)

Not Availabl

e (x)

Remarks

1 Indorsement Letter 2 Evaluation Report of DREC 3 DepEd School ID(s) 4 Letter-request for the conversion of schools into

Integrated Schools (IS) addressed to the Schools Division superintendent (SDS)

5 In case of expansion of existing school: ___a. Feasibility Study on the proposed expansion of school, duly recommended/endorsed by the SDS. ___b. IS Implementation Plan, covering five (5) years to including among others, the following;

1. Current and projected enrolment for (5) years,by grade level;

2. Proposed budgetary requirements for Personnel Services, MOOE, and Capital Outlay.

3. Operational Plan regarding curriculum and Instructional Supervision of the proposed IS; and

4. School Site Development Plan to include proposed school buildings, as needed.

___c. Certification Signed by the School Head, duly attested by the SDS on the excess classrooms, tables, chairs and other resources to be used for the expansion the elementary or secondary school; ___d. Inventory of learning resources prepared by the School’s Property Custodian, as validated by the Schools Division Office (SDO);. ___e. Updated Personnel Services Itemization and Plantilla of Personnel (PSIPOP) of the Concerned school(s); and ___f. Updated Status Report with regard to the Schools existing crucial resources.


2

6 In case of merging or combination of existing elementary and secondary school(s): __a. Feasibility on the proposed merging or Combination of schools, duly recommended/ Endorsed by the SDS. __b. IS Implementation Plan, covering five (5) years to including among others, the following;

1. Current and projected enrolment for (5) years,by grade level;

2. Proposed budgetary requirements for Personnel Services, MOOE, and Capital Outlay.

3. Operational Plan regarding curriculum and Instructional Supervision of the proposed IS; and

4. School Site Development Plan to include proposed school buildings, as needed.

___c. Inventory of learning resources prepared by the School’s Property Custodian, as validated by the Schools Division Office (SDO);. ___d. Updated Personnel Services Itemization and Plantilla of Personnel (PSIPOP) of both school To be integrated. ___e. Map, preferably drawn to scale, showing the distance of the existing schools within the catchment area of the proposed new school, duly certified by the Municipal/City Engineer and validated by the Schools Division Office. ___f. Duly notarized MOA on merging or combination of school, drawn up by and between the School Heads of both schools indicating among others, then integration of crucial resources for the proposed IS.

7 Sangguniang Bayan/Panglungsod Resolution supporting the conversion of school(s) into an IS, duly approved by the Municipal/City Mayor, indicating therein the proposed name of the school.

8 Certification from the LGU signed by the Municipal/City Mayor, as the case may be, where the LGU shall continue to provide funds for the operation and maintenance for at least 5 years or until such time that such funds are incorporated in the national Budget.

9 Designation Order for the proposed School Head. 10 Transcript of Records, Certificate of Relevant Training,

Service record and Civil Service elegibility of the proposed School Head, duly certified as true copy by the Division Office’s Record Unit.

11 Justification by the SDS, in case the proposed School Head does not meet the qualification standard for School Head item for secondary school.

12 Certification from the SDS as to the school assignment of the other School Head who will not be selected, in case both schools to be merged or combined are with existing School Heads.

3



Findings/Recommendations: ____________________________________________________________________________

____________________________________________________________________________

Validated by: Date of Validation: __________________________ __________________________ QAD EPS (Name and Signature) Noted by: ________________________ Chief ES, QAD

1

PROCESSING SHEET FOR APPLICATION FOR CONVERSION OF SCHOOLS High Schools classified as Non-Implementing Unit into a High School classified as

Implementing Unit Pursuant to DepEd Order No. 40, s. 2014.

(Items A.4, C.3 pp. 2-3; 8.4.c.2 pp 24-26; D-4d pp 80-84; Annex 4c.d pp 45-46)

Registered Name of School: _______________________________School ID: _______ Complete Address of School:_______________________________________________ Name of School Administrator___________________________Contact No.__________ Course Application:________________________________________________________ School Year:____________________________Date Submitted to ROV:______________

No.


Available (√)

Not Available

(x)

Remarks

1 DREC Evaluation Report 2 School’s latest and updated Personnel Itemization

and Plantilla of Personnel (PSIPOP).

3 Approval of school’s Agency Code by DBM. 4 Designation documents duly signed by the School

Head.

5 Certificates of Training attended by the designated/appointed financial staff related to financial management.

6 Certification of the School Head as to the capability of the school to comply with the submission of financial reports to the oversight agencies such as COA, DBM, NEDA, House of Representatives, etc.

7 Copy of the General Appropriation Act (GAA) were the appropriation of the school is reflected.

8 Enhanced Basic Education Information System (EBEIS) data on enrolment per grade level for the current school year.

9 Letter-request from the School Head addressed to the Schools Division Office (SDO).

10 Endorsement Letter from the SDO to the Regional Office.

11 Endorsement Letter from the Regional Office to the Central Office..


2



Findings/Recommendations: ____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

Evaluated by: Date of Evaluation: ________________________________ _______________________ QAD EPS (Name and Signature) Noted by: ________________________ Chief ES, QAD

1

PROCESSING SHEET FOR APPLICATION FOR CONVERSION OF SCHOOLS High School to Science High School Pursuant to DepEd Order No. 40, s. 2014.

(Items A.4; C.2 pp. 12-13; B.4; C.2 pp. 24-26, D.4 pp. 80-84; Annex 4c, 4d pp 45-46)

Registered Name of School: _________________________________School ID: ______ Complete Address of School:_______________________________________________ Name of School Administrator___________________________Contact No.__________ Course Application:________________________________________________________ School Year:____________________________Date Submitted to ROV:______________

No.


Available (√)

Not Available

(x)

Remarks

1 Indorsement letter 2 Evaluation Report of DREC 3 Certification of National Achievement Test (NAT)

Result

4 Certification of the organizers of International/National/Regional Mathematics and Science Competitions.

5 Current school Program, signed by the School Head and approved by the Schools Division Superintendent (SDS).

6 Copy of curriculum guide and special science curriculum.

7 Certified true copies of Transcript of Records of School Head.

8 Certified true copy of Certificate of Training in Science/ Mathematics subject attended by the School head.

9 Certified true copy of the Transcript of Records of Science and Mathematics Teachers

10 Copy of the LET-PRC Ratings of teachers indicating their field of specialization, concentration (e.g. mathematics, physical science, biological science, chemistry, general science, etc.).

Evaluated by: Date of Evaluation: ________________________________ _______________________ QAD EPS (Name and Signature) Noted by: ________________________________ Chief ES, QAD


1

PROCESSING SHEET FOR APPLICATION FOR CONVERSION OF SCHOOLS

High School to a Technical-Vocational school Pursuant to DepEd Order No. 40, s. 2014.

Registered Name of School: _______________________________School ID: _______ Complete Address of School:_______________________________________________ Name of School Head: _________________________________Contact No.__________ Course Application:________________________________________________________ School Year of Intended Operation:_________Date Submitted to ROV:______________

No.


Available (√)

Not Available

(x)

Remarks

1 Indorsement Letter from the SDS 2 Evaluation Report of DREC 3 Letter of Intent of SH addressed to the RD through

the SDS

4 Current School Program signed by the School Head and approved by the SDS.

5 Copy of the Technical-Vocational guide (Competency-Based Curriculum) and special technical-vocational curriculum.

6 Approved from the Office of the Undersecretary for Program and Projects on the technical-vocational course to be offered by the school, aligned with TESDA Training Regulations.

7 Certification from the School Head that the technical-vocation course being offered: ___a. is relevant to the needs of the community/local Industry. ___b. has available localized curriculum In Partnership with the local industry/ies; and ___c. is based on specialization aligned with TESDA Training Regulations, for assessment and employment purposes.

8 Notarized Feasibility Study, duly recommended by the SDS, indicating the following: ___a. Need to convert to Technical-Vocational School; ___b. Current and projected enrolment for a period of five (5) years; ___c. Demand to open a Technical-Vocational course; ___d. Organizational Structure; ___e. School Development Plan; and ___f. Proposed Budget/Budgetary Requirements.

9 Certified true copies of Transcript of Records of School Head.

10 Certified true copy of National Certificate (NC) or higher certificate for technical-vocational course attended by the School Head as issued by TESDA.

11 Certified true copy of the Transcript of Records of Technical-Vocational Teachers


2

12 Certified true copies of NC II or higher certificate issued by TESDA of Technical-Vocational Teachers on special technical-vocational skills.

13 Copy of the LET-PRC Ratings of teachers indicating their field of specialization/concentration.

14 Updated Teacher’s Profile. 15

Inventory of learning resources per specialization prepared by the School’s Property Custodian and validated by the Schools Division Office.

16 Certification on the School Head that the relevant resources of the school are adequate, duly validated by the SDO

17 Sangguniang Bayan/Panglungsod Resolution supporting the conversion of the school, duly approved by the Municipal/City Mayor, indicating therein the proposed name of the school

18 Certification from the LGU signed by the Municipal/City Mayor, as the case may be, where the LGU shall continue to provide funds for the operation and maintenance for at least 5 years or until such time that such funds are incorporated in the national Budget.

19 Any document such as but not limited to Deed of Donation, Deed of sale or Contract of Usufruct for 50 years executed in favor of Deped; Original Certificate of Title (OCT) or Transfer Certificate of Title (TCT) in the name of DepEd, reflecting the size and boundaries of the school site.

20 Justification from the SDS in case the required size of technical-vocational school site cannot be met.

Notes:

a. Please indicate N/A, if not applicable b. Kindly submit all the lacking documents on or before_______________ c. Documents to be submitted must be two (2) sets, placed in separate folders,



_______________________________________________________________________________

_______________________________________________________________________________

Validated by: Date of Validation: ________________________________ _______________________ QAD EPS (Name and Signature) Noted by: _______________________ Chief ES, QAD

1

PROCESSING SHEET FOR APPLICATION FOR ESTABLISHMENT OF A STAND- ALONE SENIOR HIGH SCHOOL (SHS)

Pursuant to DepEd Order No. 51, s. 2015. Registered Name of School: ________________________________________________ Complete Address of School:_______________________________________________ Name of School Administrator___________________________Contact No.__________ Course Application:________________________________________________________ School Year:____________________________Date Submitted to ROV:______________ No.


Available (√)

Not Available

(x)

Remarks

1 Indorsement letter 2 Letter-request from interested parties addressed to

the Schools Division superintendent (SDS) e.g. from PTA or Barangay Council, etc., or recommendation from the SDS to open a stand-alone SHS ___a. Justification on the need to establish a stand-alone SHS.

3 Track(s),Strand(s) to be offered as well as their respective number of prospective enrollees.

4 School Environment (environmental scanning/ situation analysis)

16 List and types of establishment and industries in the community, as attested to by the Department of Trade and Industry, Department of Labor and Employment (DOLE) or the Municipal Planning Officer

17 Certification from the SDS that the track (s) and strand (s) to be offered are aligned with the Local Development Plans, as evident in the list provided by the Municipal/City Mayor , and are decided upon by the RD od SDS, Division Planning Officer.

18

Result of internal assessments or surveys done with the prospective enrollees.

19 List of tracks and strands to be offered, duly signed by the RD or SDS, Planning Officer and School Head.

20 Accomplished SHS Site Appraisal Form (refer to Annex E).

21 SHS building plan indicating the number and technical specification of the classrooms to be built.

22 SHS building permit issued by the City/Municipal Engineer.

23 Bureau of Fire Protection Certificate 24 In case classrooms are already constructed,

Inspection Report fro the Division In-Charge of Facilities Section.


26 Immersion Deployment Plan.


Kean Alicante

2




_______________________________________________________________________________

_______________________________________________________________________________

Evaluated by: Date of Evaluation: ________________________________ _______________________ QAD EPS (Name and Signature) Noted by: _____________________ Chief ES, QAD

1

PROCESSING SHEET FOR APPLICATION FOR ESTABLISHMENT OF PUBLIC ELEMENTARY/SECONDARY SCHOOL

Pursuant to DepEd Order No. 40, s. 2014

Registered Name of School: ________________________________________________ Complete Address of School:_______________________________________________ Name of School Administrator___________________________Contact No.__________ Course Application:________________________________________________________ School Year:____________________________Date Submitted to ROV:______________

No.


Available (√)

Not Available

(x)

Remarks

1 Indorsement letter 2 Letter request to open a school addressed to the

Schools Division Superintendent (SDS) (Either from PTA or Barangay Council).

3 Feasibility study, duly recommended/endorsed by the SDS including the following:

a. Justification on the need to establish a school; b. Proposed Organizational Structure; c. School Environment (Environmental

scanning/situational analysis); d. Proposed School Development Plan; and e. Proposed Budget/Budgetary Requirements

(to cover the proposed school’s crucial resources)

4 Division Inspection Report signed by the SDS. 5 Sangguniang Bayan/Panglungsod Resolution

supporting the establishment of a school duly approved by the Municipal Mayor/City Mayor, indicating therein the proposed name of the school.

6 List of prospective enrollees per grade level, including their names, age and addresses and or school/or school where they are currently or were enrolled.

7 Justification on the need for the establishment of an MG school, if necessary.

8 Certification from the SDS that no private high school within the Municipality/City is participating in the GASTPE Program of DepEd, or that GASTPE participating high school has reach its allocation or number of available slots; OR

9 Justification by the SDS on the need to establish a public school to cater to the elementary school graduates/ students who cannot afford to enroll in a private high school.

10 Map, preferably drawn to scale, showing the distance of the existing schools within the catchment area of the proposed new school, duly certified by the Municipal/City Engineer.

11 Certification from the Municipal/City Engineer that the proposed school is not within the 2-km radius (for


2

the rural areas) and I km radius (for the urban areas) from the existing elementary/high school.

12 Justification from the SDS for the waiver on the 2 or 1 km radius requirement, if necessary.


14 Justification from the SDS in case the required size of school size cannot be met.

15 Clearance from the Provincial Mines and Geoscience Bureau (MGB) and the Regional Office of the Department of Environment and Natural Resources (DENR) stating that the proposed school site is not a high risk area.

.

16 School site development plan. 17 School building plan indicating the number and

technical specification of the classroom to be built.

18 School building design duly approved by Deped Education Facilities Division, Administrative Service.

19 School Building Permit issued by the Municipal/City Engineer.

20 Bureau of Fire Protection Certificate. 21 Inspection Report from the Division In-Charge of

Facilities Section, in case classrooms are already constructed.

22 Duly notarized MOA* by and between DepEd, represented by SDS, and LGU, represented by the Municipal/City Mayor or Provincial Governor, as the case may be, where the LGU shall provide funds for, among others, the following: ____a. Construction of the new building(s); ____b. Procurement of Educational Facilities, furnitures, textbooks and instructional materials; ____c. Operation and maintenance for at least five (5) years or until such time when funds for The purpose are incorporated in the national budget; and ____d. Salaries of teaching and non-teaching personnel, preferably at par with national salary rates.

23 Sangguniang, Bayan/Panlalawigan/Panglungsod Resolution for the purpose.

24 Certification from the Schools Superintendent that the Division Office has sufficient fund to cover resulting expenses, if any,

25 List of teaching and non-teaching personnel to be borrowed from the existing nearby school(s), duly identified by their respective Item Number Per Personnel Itemization and Plantilla of Personnel (PSIPOP) and name of school, if any.

3




_______________________________________________________________________________

_______________________________________________________________________________

Evaluated by: Date of Evaluation: ________________________________ _______________________ QAD EPS (Name and Signature) Noted by: _______________________ Chief ES, QAD

1

PROCESSING SHEET FOR APPLICATION FOR IMPLEMENTATION OF SENIOR HIGH SCHOOL (SHS) PROGRAM IN EXISTING JUNIOR HIGH SCHOOL (JHS)

AND INTEGRATED SCHOOLS (IS) Pursuant to DepEd Order No. 51, s. 2015.

Registered Name of School: ___________________School ID: ____________________ Complete Address of School:_______________________________________________ Name of School Head: _________________________________Contact No.__________ Course Application:________________________________________________________ School Year of Intended Operation:_________Date Submitted to ROV:______________

No.


Available (√)

Not Available

(x)

Remarks

1 Indorsement Letter from the SDS 2 Evaluation Report of DREC 3 Certification of the DepEd School Identification (ID)

from the Planning Office

4 Letter-request for Implementation of the SHS program addressed to the Schools Division superintendent (SDS)

5 Certification signed by the SDS stating that no public SHS is offering the same SHS tracks/strands/specializations within the catchment area

6 Implementation Plan, for SHS program covering five (5) years to include among others: ___a. Current and projected enrollment for (5) years, by grade level; ___b. Proposed budgetary requirements for Personnel Services, MOOE, and Capital Outlay. ___c. Operational Plan regarding curriculum and Instructional Supervision of the proposed SHS. ___d. School Site Development Plan to include proposed school buildings, as needed.

5 Certification signed by the School Head, duly attested by the SDS on the excess classrooms, tables, chairs and other resources to be used in the implementation of SHS program.

6 Updated inventory of learning resources prepared by the Property Custodian as validated by the Schools Division Office

7 Updated Personnel Services Itemization and Plantilla of Personnel of the concerned school.

8 Updated Status Report with regards to the existing crucial resources.

9 Map, preferably drawn to scale, showing the vacant lot where the proposed SHS classrooms/school building are/will be constructed, duly certified by the Municipal/City Engineer.


2

10 List of prospective enrollees in SHS per track, strand and specialization indicating their names, Learner Reference Numbers (LRNs), ages, addresses, name of schools, and DepEd School ID Numbers where they are currently or previously enrolled with justification signed by the SDS, in case the required minimum enrolment and/or number of tracks/strands/specializations are not satisfied.

11 List and types of establishment and industries in the community, as attested to by the Department of Trade and Industry, Department of Labor and Employment or the Municipal Planning Officer.

12 Certification from the SDS that the track/s, strand/s and specialization/s to be offered are aligned with the Local Development Plans, as evident in the list provided by the Municipal/City Mayor , and are decided upon by the Regional Director, SDS, Division Planning Officer, and School Head concerned.

13 Result of internal assessment or survey done with the prospective enrollees.

14 List of tracks, strands, and specializations to be offered, duly signed by the RD or SDS, Planning Officer and School Head.


16 Immersion Deployment Plan signed by the School Head

17 Certification of Authenticity and Veracity duly notarized

Notes:




_______________________________________________________________________________

_______________________________________________________________________________

Validated by: Date of Validation: ________________________________ _______________________ QAD EPS (Name and Signature) Noted by:

_________________________ Chief ES, QAD

1

PROCESSING SHEET FOR APPLICATION FOR MERGING OF ELEMENTARY/SECONDARY SCHOOLS

Pursuant to DepEd Order No. 40, s. 2014.

Registered Name of School: ________________________________________________ Complete Address of School:_______________________________________________ Name of School Administrator___________________________Contact No.__________ Course Application:________________________________________________________ School Year:____________________________Date Submitted to ROV:______________

No.


Available (√)

Not Available

(x)

Remarks

1 Indorsement letter 2 DepEd School ID of the school to be merged. 3 Map, preferably drawn to scale, showing the

distance of the existing schools within the catchment area of the proposed new school, duly certified by the Municipal/City Engineer and validated by the Schools Division Office.

4 Letter-request on the proposed merging of schools addressed to the Schools Division superintendent (SDS)

5 Feasibility Study on the proposed merging of schools, duly endorsed by the SDS.

6 Proposed School’s Implementation Plan, as merged, covering five (5) years to including among others, the following; ___a. Current and projected enrollment for (5) years, by grade level; ___b. Proposed budgetary requirements for Personnel Services, MOOE, and Capital Outlay. ___c. Strategic Plan regarding curriculum and Instructional Supervision of the proposed School; ___d. School Site Development Plan of the schools to be merged, including proposed school buildings, as needed.

7 Updated Status Report of the schools to be merged with regard to their existing crucial resources.

8 Inventory of learning resources prepared by the Property Custodian. of both schools to be merged.

9 Updated Personnel Services Itemization and Plantilla of Personnel (PSIPOP) of both schools to be merged.

10 Duly notarized MOA on merging of schools, drawn up by and between the SDS and School Heads concerned indicating among others, the crucial resources to the proposed merged school.

11 Designation Order for the OIC/TIC of the merged schools, duly signed by the SDS.

12 Sangguniang Bayan/Panglungsod Resolution supporting the Merging of the schools, duly


2

approved by the Municipal/City Mayor, indicating therein the proposed name of the school.

13 Certification from the LGU signed by the Municipal/City Mayor, as the case may be, where the LGU shall continue to provide funds for the operation and maintenance of the merged school.

14 Any document such as but not limited to Deed of Donation, Deed of sale or Contract of Usufruct for 50 years executed in favor of Deped; Original Certificate of Title (OCT) or Transfer Certificate of Title (TCT) in the name of DepEd, reflecting the size and boundaries of the school site of both schools.

Notes:




_______________________________________________________________________________

_______________________________________________________________________________

Evaluated by: Date of Evaluation: ________________________________ _______________________ QAD EPS (Name and Signature) Noted by: _____________________ Chief ES, QAD

1

PROCESSING SHEET FOR APPLICATION FOR SEPARATION OF SCHOOL ANNEX

Pursuant to DepEd Order No. 40, s. 2014.

Registered Name of School: _________________________________School ID: _______ Complete Address of School:_______________________________________________ Name of School Administrator___________________________Contact No.__________ Course Application:________________________________________________________ School Year:____________________________Date Submitted to ROV:______________

No.


Available (√)

Not Available

(x)

Remarks

1 Indorsement letter 2 Certification of DepEd School ID prepared by the

Planning Unit.

3 Approval on the establishment of school annex by DepEd Central/Regional Office.

4 Sangguniang Bayan/Panglungsod Resolution supporting the separation of the school annex, duly approved by the Municipal/City Mayor, indicating therein the proposed name of the school.

5 Request for separation of the school annex concerned, duly recommended/endorsed by the School Division Superintendent (SDS) and/ or stakeholders;

5 Feasibility Study, indicating the following: a. Justification on the need to separate a school annex. b. Proposed Organizational Structure; c. School Environment (environmental

scanning/situational analysis); d. Proposed school Development Plan; and e. Proposed Budget/Budgetary requirement.

6 Inventory of crucial resources to be transferred to the proposed school to be separated, duly signed by the mother school’s Property Custodian.

7 Duly notarized MOA regarding the separation of school annex, drawn up by and between the School Head of the mother school and Officer In-Charge (OIC) Teacdher In-Charge (TIC) of the school annex, indicating among others, the transfer of crucial resources to the proposed regular school, as follows; a. Teaching and non-teaching items pursuant to the existing DepEd-DBM staffing standards for schools; b. Funds for personnel services based on the actual salaries of the school personnel both teaching and non-teaching) to be transferred; c. Funds for Maintenance and Other Operating Expenses (MOOE); e .Other funding requirements until such time that

the school’s funding requirement in integrated


2

in the General Appropriation Act (GAA). 8 Justification from the School Head of SDS in case

the required MOA (from item 7 above) cannot be met.

9 Latest and updated Personnel Services Itemization and Plantilla of Personnel (PSIPOP) including proposal for item for Principal I and additional teachers and support personnel.

10 List of enrollees by grade level, duly signed by the School Head/Teacher-In-Charge and attested by the SDS.

11 Justification from the SDS in case item 10 cannot be met.


13 Justification from the SDS in case item 12 cannot be met.

Notes:




_______________________________________________________________________________

_______________________________________________________________________________

Evaluated by: Date of Evaluation: ________________________________ _______________________ QAD EPS (Name and Signature) Noted by: ______________________ Chief ES, QAD

ANNEX B: DepEd Memorandum No. 4, s. 2014 – Guidelines on the Preparation for the National Implementation of the Senior High School (SHS) Program in Non-

DepEd Schools for the School Year (SY) 2016-2017 and Onwards

ANNEX C: DepEd Central Office Client Feedback

Form

Republic of the Philippines Department of Education

Republic of the Philippines

Department of Education

Privacy Notice: The personal information included in this document should only be used for the purposes of administering the survey. Any personal information included herein may not be used for other purposes aside from those stated above.

Privacy Notice: Ang mga personal na impormasyon sa dokumentong ito ay maaari lamang gamitin pra sa layunin ng survey. Hindi ito gagamitin sa iba pang mga layunin maliban sa nabanggit.

Client Feedback Form Control No.: ___

Your experience matters to us!

I. Client Information Name (Optional): ______________________________________________ Date Visited: ____/____/_________ Office Visited: ________________________________________________ Phone No. (Optional): ____________ Purpose of Visit (Please specify): ________________________________________________________________ Time Started: _________ Time Finished: _________ II. Client Satisfaction Rating Kindly rate the quality of service provided by checking the appropriate box.

Very Dissatisfied Dissatisfied Neutral Satisfied Very Satisfied

1. PHYSICAL The environment is clean and orderly

2. SERVICES Your concern was addressed promptly and appropriately

3. PERSONNEL The employee was courteous and accommodating

*OVERALL RATING FOR THE SERVICE PROVIDED: How satisfied are you with the quality of services provided?

III. Suggestions/Compliments/Comments ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Thank you for your valuable input to help us continuously improve our services!

Client Feedback Form Control No.: ___

Ang iyong karanasan ay mahalaga sa amin!

I. Impormasyon ng Kliyente Pangalan (Opsyonal): _____________________________________ Petsa ng Pagbisita: ____/____/_________ Opisinang Bibisitahin: ___________________________________________ Phone No. (Opsyonal): ___________ Layunin ng Pagbisita: _________________________________________________________________________ Oras Nagsimula: _________ Oras Natapos: _________ II. Client Satisfaction Rating Lagyan ng tsek ang kahon na tumutugma sa inyong sagot.

Very Dissatisfied Dissatisfied Neutral Satisfied Very Satisfied

1. PISIKAL Ang kapaligiran ay malinis at maayos

2. SERBISYO Ang pangangailangan ay natugunan ng maayos at karapat dapat

3. KAWANI Ang kawani ay magalang at maasikaso

*OVERALL RATING FOR THE SERVICE PROVIDED: Gaano ka kakuntento sa kalidad ng mga serbisyong naibigay?

III. Suhestiyon/Papuri/Komento ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Maraming salamat sa inyong tulong sa para sa ikauunlad ng aming serbisyo!

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