Republic of the Philippines

NUEVA VIZCAYA STATE UNIVERSITY

STUDENT AFFAIRS & SERVICES
Bambang, Nueva Vizcaya 3702
“Student’s Success is Our Business”
APF Number:

ACTIVITY PERMIT FORM

(To be filled by SDPS Dept. Chair)

Date of Filing:
(MM/DD/YY) 10 03 19
SERIES OF 2019-2020
Title of Activity:

CYM GRANDLAUNCHING
Requesting Organization:

Campus Youth Mission

TYPE OF ACTIVITY REACH OF ACTIVITY NATURE OF ACTIVITY
□ In-Campus Activity □ Campus Wide □ Academic □ Community Development
□ Off-Campus Activity □ College Wide □ Meeting □ Organizational Development
□ Department Wide □ Seminar □ Environmental Concern
□ Organization Wide □ Competition □ Cultural Awareness
□ Officers □ Extension □ Others: ________________________________
Date:
From OCTOBER 03, 2018 To
Time:
From 5:00 pm To 6:00 pm
Venue: COLLEGE OF ARTS AND SCIENCES ROOM 208
1 To officially launch the Campus Youth Mission for the A.Y. 2019-2020.
2
Objectives:
Purpose /

5
Informa
Activity
Other

tion:

OFFICERS OF THE REQUESTING ORGANIZATION ADVISERS OF THE REQUESTING ORGANIZATION

NO. NAME POSITION SIGNATURE NO. NAME. SIGNATURE
1 Nick c. Viernes, Jr. President 1 Shelita H. Jubay

2 Marjorie dela Cruz Secretary 2

3 3

4 4

5 5

Recommending Approval:

ROLAN S. QUIAPE JULIUS P. SUMALING

Department Chair, Student Development Programs & Services Campus Coordinator, Student Affairs and Services

Approved:

CARLO F. VADIL, DPA

Campus Administrator
Notes:
1 Accomplish in quadruplicate.
2 File fifteen days before the date of the activity.
3 Return a copy to the SDPS Department Chair once approved by the Campus Administrator for filing.
Conditions/Requirements for Approval:
1 All students’ activities/gatherings beyond 6:00 pm or conducted outside NVSU Campus or scheduled during non-class days require students’
parental approval and the presence of faculty adviser(s) and/or Dean of the College or his representative until the end of the activities.
2 For seminars, programs and the like, submit the program of activities.
Other Condition(s) to follow:
1 Evaluate the activity by the participants after the conduct of the said activity.
2 Documentation of the approved activity.
3 Submission of the complete report of the approved activity to the Office of Student Affairs (Include program of activity, photos, evaluation
and request form).
Revised September 2017 | ASTN