HRDO Form C-1

Revised Jan. 4, 2008

UNIVERSITY OF THE PHILIPPINES DILIMAN

HUMAN RESOURCES DEVELOPMENT OFFICE

APPLICATION FOR PRIVILEGE TO STUDY AT REDUCED FEES

Name : _____________________________________ Designation: _________________________

Student No.: _____________ College enrolling in: ____________ Home Unit: __________________________

_____ Semester/Summer/Trimester
AY __________

Subjects Days TIme UnIts

_____________________ ______________ ______________ ________________
_____________________ ______________ ______________ ________________
_____________________ ______________ ______________ ________________
Total Unit Enrolled in: ________________

______________________
Signature

ACADEMIC LOAD OF APPLICANT (If applicable only) CLEARANCE:

[To be filled out by Department Chairman]
[ ] Tenured
Actual teaching load units : _________ [ ] Non-tenured ____________________
Unit credits for non-teaching activity - [ ] On study leave___________________
a) Research : _________ [ ] On vacation leave with pay ________
b) Administrative Work : _________
c) Study : _________ For enrollment in not more than _______
Total Units : _________ units with only _______ units at reduced fees.
Inclusive dates of current
Appointment: _______________________________________

RECOMMENDED BY:

______________________ ______________ ANGELA D. ESCOTO

Chairman Date Director
Human Resources Development Office
______________________ ______________
Dean/Director/Head Date

RECOMMENDING APPROVAL / APPROVED: RECOMMENDING APPROVAL/APPROVED:

(For Faculty/REPS) (For Administrative)

BENITO M. PACHECO VIRGINIA C. YAP

Vice-Chancellor for Academic Affairs Vice Chancellor for Administration

APPROVED:
(For more than 18 units academic load)

MICHAEL L. TAN
Chancellor