Form A

Name of SUC: ________________________________________________ Region: ______Address: _____________________________________________________

Program/Course Total Head Count Total Enrolled Units Total Weighted Enrolled Units POINTS

Total Head Count refers to the number of students (both full-time or part-time) enrolled in a particular program. Total Enrolled Units refers to the totality of the units enrolled by students in a particular program or discipline. This figure should reflect the number of units enrolled by both full-time and part-time students.

Laboratory School (not to exceed 500 heads each for Elementary and Secondary) 0.25 Agriculture 2.00Public Administration/Business/Industry/Legal Education and Related Courses 0.75 Science/Mathematics/Engineering/I.T. 2.50

Humanities, Social Sciences and Communications 1.00 3.00

1.00 3.50Health 1.50

since they have remained focused on their specialization.

Total weighted enrolled units should follow the program or discipline where the student is enrolled and not the discipline of the enrolled subjects.

Certified Correct: __________________________________________

Table A1. Number of Actual Weighted Enrolled Units (as of 1st Sem AY 2010/11)

Total Weighted Enrolled Units refers to the total enrolled units of students in a particular program multiplied by the weights given as follows:

Masteral Programs2

Teacher Education1 Doctoral Programs2

1 Teacher Education Programs of Phillippine Normal University , Cebu Normal University and Leyte Normal University shall be given a weight of 1.5

2 Graduate Programs of Public Administration, Management and Legal Education shall have the same weights as their undergraduate programs.

Form A

Name of SUC: ________________________________________________ Region: ______ Name of Head/Office of the Registrar

Form A

Name of SUC: ________________________________________________ Region: ______Address: _____________________________________________________

Program/CourseAccreditation COE/COD (Please check.)

POINTSLevel Date Applied Date Re-applied Points COE COD Points

Total TotalPlease list down or enumerate only the courses which have been granted accreditation and/or COE/COD status. Please indicate the level under the accreditation column. Date applied refers to the date when the program was first applied for acreditation. Date re-applied referes to the date the program was applied for re-accreditation.Please check the column corresponding to the COE/COD status.

Certified Correct: __________________________________________

Table A2. Accreditation Status or COE/COD

Name/SUC President

Form A

Name of SUC: ________________________________________________ Region: ______Address: _____________________________________________________

Institutional Performance National Performance

POINTSNumber of Passers Number of Examinees Total%

Number of Passers Number of Examinees Total%

2007 2008 2009 2007 2008 2009 Passers Examinees 2007 2008 2009 2007 2008 2009 Passers Examinees

1

The % columns under both the Institutional and National Performance refer to the accumulated number of passers for the three years indicated divided by the

accumulated number of examinees for the same three years.

Certified Correct: __________________________________________

Table A3. PRC Performance

Board and/or Bar Examination

Nameof Head /Office of Academic Affairs

Form A

Name of SUC: ________________________________________________ Region: ______Address: _____________________________________________________

(Please provide separate listings for full-time and part-time faculty by educational qualification with indicated number of hours of teaching load and indicating if actively enrolled in a masters

or doctoral degree during the first semester of AY 2010/11.)

Note: Teaching hours of part-time faculty should be converted to full-time equivalent.Number % POINTS

a. Faculty with Masters Degree b. Faculty Actively Pursuing their Master's c. Faculty with Doctoral Degree d. Faculty Actively Pursuing their Doctoral Degrees e. Others

TotalThe % column refers to the number of faculty under each classification divided by the total number offaculty. Part-time faculty shall be converted into full-time equivalent by dividing their teaching load by regular teaching load of 18 units. For example, a part-time faculty with a 9-unit teaching load will beequivalent to 0.5 faculty.

Certified Correct: ____________________________________________

Table A4. Faculty Profile (as of 1st sem. AY 2010/11)

Name of Head/Human Resource Management Unit

Form A

Name of SUC: ________________________________________________ Region: ______Address: _____________________________________________________

Title Number of Beneficiaries

1st sem SY 2008/09 1st sem SY 2009/10 1st sem SY 2010/11 Average POINTS

TotalPlease indicate the title of each merit scholarship. The average column is obtained by summing-up the number of beneficiaries for the three years indicatedand dividing the sum by 3. The average is used to avoid double-counting of scholars.

Certified Correct: __________________________________________

Table A5. Merit Scholarship Programs (Please attach list of scholars.)

Name of Head/ Office of Academic Affairs

Form B

Name of SUC: ________________________________________________ Region: ______Address: _____________________________________________________

Author(s) Title of Article Name of Book/Journal Editor(s)Vol.No/ Number Year of Publication

POINTSIssue No. of Pages Publication National International

TotalAuthors here refer to full-time faculty or staff whether permanent, temporary or contractual who are still in service during the years in review.*Refereed publications may include articles or books which resulted from research conducted before the years in review. Refereed publications will be validated based on CMO No. 9 series of 2010. Provide a copy of each publication or acceptance for publication for those which have yet to be published in 2009.*Part-time faculty and staff are not included to emphasize exclusivity of researchers and research outputs across SUCs. Inclusion of part-time faculty and staff mayresult to double-counting of researchers and research outputs across SUCs.

Certified Correct: ______________________________________________Head, Reseach Unit

Table B1. Refereed Publications Within The Last Three Years (2007-2009)

Form B

Name of SUC: ________________________________________________ Region: ______Address: _____________________________________________________

Researcher(s) Title of Research PaperTitle, Venue and Date of Conference Where the Research Output Was Presented Type of Conference

POINTSTitle Venue Date Organizer National International

TotalResearchers here refer to full-time faculty or staff whether permanent, temporary or contractual who are still in service during the years in review.*Papers presented may include those which resulted from research conducted before CY 2007 as long as the date when presented falls within the years in review.Provide a copy of proceedings or conference program when the paper was presented. Please check whether the conference was national or international.

Certified Correct: _____________________________________________Head, Reseach Unit

Table B2. Papers Presented Within The Last Three Years (2007-2009)

Form B

Name of SUC: ________________________________________________ Region: ______Address: _____________________________________________________

Invention(s) Patent Number Date of Issue POINTS Utilization of Invention

Name of Commercial Product POINTSDevelopment Service End-Product

Total TotalInventions may include those that resulted from researches conducted before CY 2007 as long as the date of patent grant falls within the years in review.

service provision, or as an end-product in itself or it may also be commercialized for selling to other end-users. Please indicate its utilization by ticking the corresponding column and its commercialization by specifying the brand name of the commercial product. Provide a copy of the abstract for each patent.

Certified Correct: ______________________________________________Head, Reseach Unit

Table B3. Inventions Within The Last Three Years (2007-2009)

Inventions should include only those which have been invented by researchers as defined in Table B2. An invention may be utilized for development of technology, for

Form B

Name of SUC: ________________________________________________ Region: ______Address: _____________________________________________________

Researcher(s) Title of JournalVol. / Issue/ City/Year

Name of Publisher POINTSPage No. Published

TotalCited research outputs refer to those which must have been cited in refereed articles or books published nationally or internationally within the years in review.

Certified Correct: ______________________________________________Head, Reseach Unit

Table B4. Research Output As Cited by Other Researcher(s) in Journal Articles Within The Last Three Years (2007-2009)

Title of Research Output

Author(s) Who Cited the Research Output

Title of Article Where the Research Output Was Cited

Research outputs should only include those which have been conducted by researchers as defined in Table B2.

Form B

Name of SUC: ________________________________________________ Region: ______Address: _____________________________________________________

Name of Researcher Title of Research Output/AwardYear Published/Accepted/ Publisher/Conference Organizer/

POINTSPresented/Received Conferring Body

TotalResearchers should be full-time faculty or staff whether permanent, temporary or contractual who are still in service during the years in review. Research outputs refer to those reseearch-based papers published/accepted for publication /presented/patented during the years in review.

Certified Correct: ______________________________________________Head, Reseach Unit

Table B5. List of Researchers With Outputs and/or Awards in the Last Three Years (2007-2009)

Form C

Name of SUC: ________________________________________________ Region: ______Address: _____________________________________________________

Table C. List of Recognized Extension Programs/Projects* Within the Last Three Years (2007-2009)

TITLECitation/Recognition Received

POINTSTitle Conferring Agency or Body

Total Total*An extension program/project is defined as a set of activities aimed to transfer knowledge or technology or to provide services to the community in consonance with the programs offered. The extension program is conducted not as part of academic requirement but as an outreach towards the improvement of the community's quality of life. Please attach Board Action/Resolution approving the Extension Program and/or citation/recognition received. For program/project components or activities not specified in the approved Board Action/Resolution, please attach budget indicating such.

Certified Correct: __________________________________________

Duration/ Number of

Hours

Number of Trainees/

BeneficiariesYear

Received

Form C

Name of SUC: ________________________________________________ Region: ______ Head, Extension Unit

Form D

Name of SUC: ________________________________________________ Region: ______Address: _____________________________________________________

Table D.1. Income ( 1 January, 2007 to 31 December, 2009)CY 2007 CY 2008 CY 2009

Amount % Amount % Amount % D.1.1 Income Operating Income Internally Generated Income Pxxxx Pxxxx Pxxxx Tuition Fees xxxxx xxxxx xxxxx Other Income Collected from Students xxxxx xxxxx xxxxx Income from Other Sources xxxxx xxxxx xxxxx Income from Revolving Fund xxxxx xxxxx xxxxx Grants and Donations xxxxx xxxxx xxxxx Others xxxxx xxxxx xxxxx Total Income xxxxx xxxxx xxxxx

D.1.2 Budget General Appropriations Act xxxxx xxxxx xxxxx Retirement and Life Insurance Premium xxxxx xxxxx xxxxx Total xxxxx xxxxx xxxxx Add: Continuing Appropariations xxxxx xxxxx xxxxx R.A. No Pxxxx Pxxxx Pxxxx

Releases from Special Purpose Funds (SPFs) Priority Development Assistance Fund xxxxx xxxxx xxxxx Contingent Fund xxxxx xxxxx xxxxx Foreign-Assisted Projects Support Fund xxxxx xxxxx xxxxx General Fund Adjustments xxxxx xxxxx xxxxx Others (pls. specify) xxxxx xxxxx xxxxx Total xxxxx xxxxx xxxxx Less: Transferred Appropriations/Allotments xxxxx xxxxx xxxxx Department of Education(Sec. Edu. Program) xxxxx xxxxx xxxxx Other Agencies (those applicable to SUCs) xxxxx xxxxx xxxxx Total Budget xxxxx xxxxx xxxxx

Total Income and Budget Pxxxx Pxxxx Pxxxx

Certified Correct: _______________________________________________ Head, Financial Management Unit

Form D

Name of SUC: _______________________________________________________ Region: ______Address: ___________________________________________________

Table D.2 . Active Human Resource Development Program (AY 2009/10)

Title/Description Number of Beneficiaries

a. Faculty

b. Non-Faculty

Active Human Resource Development Program - an HRD Program currently being implemented as indicated by the % of staff/ faculty who have availed of the training within the year under review. At least 1% of the faculty or staff must have benefitted for an HRD to be counted.

Certified Correct: __________________________________________ Head, Human Resource Development Unit