Republic of the philippines

Department of Education
Region III
DIVISION OF CITY SCHOOLS
City of Malolos, Bulacan
TeL lFax Nq. (044) 662-144A1644-41 72
E -mail Address : deoedmalo los1i @yah.oo.com webiite; www. depedmalolos. com

. ":i'

APPLICATION FOR PERMISSION TO STUDY

Name of Applicant: Position:

Civil Service Eligibility: Civil Status:
Name of School where employed: Barrio:
Municipality: Perm'/Provl:
Distance in Kms between official station irry:

(Name and I-ocation of college where applicant wishea lo er,rotg

Course applied for:

Academic Year: Qtr/Sem. Summer:
(1tt, 2nd, 3'd , 4th)
Course to be taken this term and the schedule:

COURSE DAYS OF THE WEEK HOURS OFTHE WEEK

Credits or units towards - - BSE MA Ed.D / PH.D

Total number of units previously
Number of units to be earned this Qtr./Sem./Summer:

I hereby certify that I have carefully read the information on the page of this form, all the provisions of
which I am bound to observe very strictly, I understand that the regulations on the outside study of teachers are
intended to primarily safeguard the health of the teachers as well as of course to maintain their efficiency in the
service. I also understand that if in the opinion of the Division Superintendent of School this study adversely affect
my efficiency as a teacher this permission to study shall be revoked.

(Signature of Applicant)
Date Submitted:

APPROVAL RECOMMENDED

The undersigned shall require strict compliance by the applicant with all the existing rules and regulations
regarding permission to study and should hold responsible for any undue delay in forwarding the applicant to the
office doing satisfactory work with an efficiency rating of "ABOVE AVERAGE' or higher. The applicant will be
required by me to submit through office, to the Division Superintendent a certified copy of the report rating obtained
in the course which should be attended to his/her outside study not earlier than thirty minutes after the afternoon
session in the public school.

Date Submitted: _
W 0fficg"h.ftrr
Asrt Schosh 0tyLmn trWtnUrful (School Principal)
APPROVED:
This permit expires on:
Date:
Permit No.
 -:. ,

1. ,qpp{t{$r,s{1 r*r fierrnlsgion ffi study in fiue {5} ,;q*$#"su$t reaclr. tha qfidq {lot 'qt9, l$n -r*.?-{-ZJ
mcnths b,eforelthe sfart'a;'the actuat:c!+ssp" THE TEAfHfft$ JU'SI'FiLf; RCQLIESI 8fiffrf;f;
eNqOii-tN* FSRTHg,fI*,S-{:nME It{ ANY SCHOOI-, CCLilfGg or U}*IVEPSITY-
^ari efficlent ratlng of "ABOVE
Z. The teacher applicant must "'be d*lnq .cetsffict*ry worx with

3" if,tu pui*irii*n *rcn,until.the applieaft cor*pl$e t?re cuvfrttilum t*wads a de{rree-'ile ds€s il*t
neeo'totteareauesttor:prmIssioneVeryseme5ter'
4. * [,tf*.*t flrom the- tread of'ttre schpql cr cofl*be where the mu.Fr is *nr*ll*cl *nd. the Sltbj*rt tr
pumu€d'snouldheatta*h*d'vrrith th{*ppli*ati*rl.'ri ' .' 'r ', ' '..
'
- reiitr*rs urtr*,*|g.a*oLrr'i*tfintsn
S, eauise; r:e" l',rfi* *tave semed t cft*rsf as r'.n*.lt qs-tht stif]ect
;r}g]5; icrneilused.ii1*. *os* siiil ts h* urken pti to k cqrtifFd by the Re6mtrar *f the
private

6, ahel"- e*ct.o .
'sueurintii*un'fJ xfu*er rrqry 'leaeir*r gr*ntec penrri*l*n bo: study ril*ultJ sub*itit io the
' eififA afrcr*gr chafireis, a. iertfieJ.ir** t$pv cf lfi* i€Pffri.o-t tfi* "ra&-q y
.oUiaine* in i:he .oum*:*htctl t *.t*l* duriirg rhe semester inclu*iil"rg ljr* **rnb*r *f untfs earned. In
;dd{i--, -l *--la* ii*l*rreqniri',4,* specific curgicularlawyds a;{ecree }i#she sh*uld submli a
iemplet* set of l*Jlr*i:tn*rlxrist'or grddfrs rnLJrspecial order b tht urperirrteri*efit thrsl*h his
.
lrnmediafe supericr.fsr valiclation and veiiflcaiion' '.
'', iii'x*i*lrirtriuAy
:r: -i,"-i,tb: unitr pe, seirnEter-cr'surhrn*r sh**id be srirtty
cn* to
pbseru$,
tltr** !3i
{.Srt,*il ;#.#;L*ai*atm roi gr-ndupton nTBI^lm ai}*weS lo.carry
.uni6
fr*mi {1)
rhe last units that the
rnore **":u.telii;;?fl--iil"autfruired p,rovid# that.those units ere
#h;#;--d i;;;fu;;tiem stauuate' e*emption will bepngiven
to i'io tc lhe ieachen.vrho do.not
.il1fiffi;* -56ryi &-
r*n#t*in. violaliou cf tfris r*gulatiq? the siu*v to*d *ft4!{ be Euffl{l*r}t
. cn*se f*r, ta*outi*n."or $eperfftissi+n,t* studv for:admirri*raflve.aclion'
shorrld be'accessiir*
s- ?-lte caltruq, r*tIIi'Ji *iril*#.$"vui'iip n",arteqghei 1*n**e*te* *nr#linq
I-' ts $ris oix"ai mgi;n u* rn*t,i;e ,i,rilt nci be'unclul'i ccrnnli# .rg hurry tliere'fr*ra irl *dgr tc an?vc
*i ir***u; Fl';**. ?[[:t**ct'pr-sh+utd atrgnS {q his *tlfsi{*'sfiudy 1*t earli*r than thiilry {30i
*rn*t*s inet iire a*ernc{rn lesliiurr in'the Bublic'schaol'
ror tielav in fe*uarding
l},. .The,irnnrdiar* superisi Qr qup*rvfsoi s]iali c* ngy-urryt{!"ft
"' 1nLI,]_q** }re$ h€*]? fii*# +n
rh*;d;#irl#.[i:ni,;-#dhr*d;nt,'.;r. ** upir]icatjen'bo,tirq superiniender:l
li:ne- : ,

@g* *n*n* anp;iication wish*s ta e*roll)

TO WHOM TT MAY CONCERN: a public school teacher, is seeking

This is to certifY that subject offered this
witt tt foiiowing
admissinn in this cffice to (eaurse) "

DAYS9JTg*-WTgK HPUfiSOFTHE U&EK

qilIIEi{

REGISTRAR.
DEA}{
NOTE: i

noi be earlier than 6:00 pm'

i.iVr.icryt classes in a semestral terms shouid
be taken as follows:
2. Unless suspended by the DEcs
Ebery term, a 3 unit lecture subject should
surta*Bn rbnna'r DAILY Mondav through saturday' -
* *ouns units in Law in prescriLred subjecls'
Maximum load 9 units ro.uit.ourlrs, 6 for Llnde'rsraduate cowse or 6
5EMESTRALTERM-A-tOtd Of three 1r7
n*urri risk' Maximum Loadr I "oit* not more than 6
Saturday Classes for maxim'm load
t* *r,orf"l i' ipl"*i
units of graduate fr""i
""rrrl"*r.p,
units 4'