Letterhead of the Campus

LOCAL OFF-CAMPUS ACTIVITIES

CERTIFICATE OF COMPLIANCE

This is to certify that all the processes, procedures and requirements before the conduct of the
off-campus activity/ies pursuant to CMO No. 63, series of 2017 entitled “Policies and Guidelines
on Local Off-Campus Activities” have been duly complied with, and that by virtue thereof, we
hereby assume full responsibility for the safety and welfare of the students.

Certified Correct: Reviewed by: Noted:

Personnel-in-Charge Dean Campus Director

Recommending Approval: Approved by:

Vice-President for Academic Affairs University President

SUBSCRIBED AND SWORN to before me, this ____________________, by

____________________ who exhibited to me (his/her) competent proof of identification
______________________________ issued at ____________________, Philippines on
____________________.

Doc. No. ;
Page No. ;
Notary Public
Book No. ;
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 Letterhead of the Campus

LOCAL OFF-CAMPUS ACTIVITIES

REPORT OF COMPLIANCE
(This should be accomplished PRIOR to the conduct of the activity)

Campus : ________________________________________________________
Address : ________________________________________________________

BASIC INFORMATION:

List of
Destination/s Inclusive Number of
Program Name Course Personnel-in-
and Venue Dates Student
Charge

REPORT BEFORE THE ACTIVITY:

Compliance
Activities
Yes No Remarks
1. Nature of Activity/ies
 Curricular  
o Educational Tour (more than 1 day)  
o Field Trip (lasting only 1 day)  
o Field Study, Experiential Learning or  
Related Learning Experience
 Non-Curricular  
o Mission-based activity/ies  
(retreat, recollection, etc.)
o Conventions, seminars, conferences,  
symposiums, trainings, and
teambuilding
o Volunteer work including peer helper  
programs, relief operations, community
outreach and immersion
o Advocacy projects and campaigns  
o Participation in sports activities  
o Activities initiated by recognized various  
student groups
o Interschool competitions/tournaments  
o Culture and arts performances and  
competition
If Curricular Activity/ies
1. Curriculum Requirement  
(Attach course syllabus which reflects the
relevance of requiring an educational tour and
field trip.)
 Common Requirements
1. Destination
(Proof that the destination and schedule are  
relevant to the subject matter.)
2. Handbook or Manual  
(This should include the requirements and
guidelines of the conduct of local off-
campus activity/ies.)
3. Student’s Consent  
of Parents/Guardians
(Aside from the parental consent template
issued by the Office of Student Affairs, this
document should include the title, venue,
date and detailed schedule of the
activity/ies, travel itinerary, breakdown of
the amount to be collected from the
students, mode of transportation to be
used, accommodation (if staying overnight),
curfew hours and general “house” rules)
4. Medical Clearance of Student  
(This must be secured by the student
before engaging in any preparations or
taking any actions regarding the activity/ies.
This must be signed by the University or
Government Physician.)
5. Personnel-in-Charge
 University Memorandum designating  
the employee as Personnel-in-Charge
of the activity/ies with detailed tasks,
duties and responsibilities before,
during and after the off-campus
activities.)
 Relevant certificate on first-aid training  
6. First Aid Kit  
7. Fees/Fund Source
 Duly approved schedule of fees  
(detailed breakdown of fees to be
collected from the students)
 Certificate of Availability of Funds (if  
charged against University fund or
custodial fund)
8. Insurance
 Insurance as covered by the University  
Student Insurance
 Passenger Personal Accident  
Insurance for Public Utility Vehicles, if
opted to seek third party services.)
9. Mobility of Students (Choose from the list
below)
 Owned by the University  
o University Memorandum issued for  
the purpose
o Duly Approved Trip Ticket  
o Detailed Travel Itinerary  
 Public Transportation  
o University Memorandum issued for  
the purpose
o Duly Approved Travel Order  
o Detailed Travel Itinerary  

 Third Party or Subcontracting  

Franchisee
o University Memorandum issued for  
the purpose
o Detailed Travel Itinerary  
o Contract of Service with the third  
party
o Certification from LTFRB for the  
validity of the franchise of the
 proposed operator (i.e., legitimate,
current and up-to-date), if
applicable
o Special Permit from LTFRB if  
transportation is out-of-line
o Updated/Valid documents  
pertaining to registration, insurance
coverage, driver’s license,
assurance of roadworthiness, etc.)
 Travel Agency/Tour Operator  
o University Memorandum issued for  
the purpose
o Detailed Travel Itinerary  
o Copy of Travel and Tour Operator  
Accreditation Certificate by the
Department of Tourism (DOT)
10. LGUs/NGOs
Proof/s that the activity/ies is/are properly
coordinated with the concerned agencies,
such as LGUs or NGOs.
 Copy of the letter sent to the LGUs/  
NGOs
 Copy of acknowledgment letter from the  
LGUs/NGOs
11. Activities
 Orientation to Students  
o Minutes of the Meeting  
 Consultation  
(Consultation to concerned students,
faculty and stakeholders with attached
minutes of consultation and attendee’s
signature)
o Minutes of the Meeting  
 Announcements  
(Announcement to students, faculty
and parents of the activity one (1) or
two (2) months before the scheduled
date of the conduct of off-campus
activities)
o Copy of the Announcement  
 Briefing Before the Trip  
(Consultation to concerned students,
faculty and stakeholders with attached
minutes of consultation and attendee’s
signature)
o Minutes of the Meeting  
o Detailed Travel Itinerary  
o Handy information materials for  
students
 Learning Journals  
(Provide standard format of learning
journals to students. This should
include the rationale as well as the
expected outcomes of the activity/ies.)
o Copy of the Learning Journals  

 Emergency Preparedness Plan  

(This should be included in the
handbook or manual for the conduct of
the local off-campus activities as part of
the contingency plan.)
o Copy of the Handbook or Manual  
for the Conduct of Local Off-
Campus Activities indicating or
stipulating therewith the
Contingency or Emergency
Preparedness Plan
12. Certificate of Non-Mandatory  
Requirement
(Certification that the activity/ies is/are non-
mandatory and participation is purely
voluntary. An equivalent or parallel
activity/ies for students who will not
 participate in the activity/ies must be
indicated in this document.)

Certified Correct: Reviewed by: Noted:

Personnel-in-Charge Dean Campus Director

Recommending Approval: Approved by:

Vice-President for Academic Affairs University President