Application Letter

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SAMAR STATE UNIVERSITY

Catbalogan City, Samar Tel. No. (055) 251-2139; Fax. No. (055)543-8394

Republic of the Philippines

September 13, 2010 DR. SIMON P. BABALCON JR. University President Samar State University Dear Dr. Babalcon, Greetings! With the aim of enhancing further my potentials as a college instructor of this university for the benefit of my students and the university as a whole, I am glad to inform you that I am planning to enroll for my masters degree at University of San Carlos, Cebu City with the degree Master of Physics (MoP). Also, I am taking this opportunity to avail of the second phase of the Commission of Higher Education (CHEd) Faculty Development Program. In this connection, I would like to ask permission from your good office to allow me enjoy the said scholarship. As reflected in the list of requirements for the scholarship program, the applicant must seek endorsement from the school head thru a certification (FORM A3), and a Rehiring Agreement (FORM A4) for non-permanent faculty. Forms A3 and A4 are hereto attached. I am hoping for your favorable response on this regard. Respectfully yours, DENNIS G. COSMOD Applicant Instructor-College of Arts and Sciences Noted: MELDRITO B. VALLES, Ph. D. Dean, College of Arts and Sciences Recommending Approval: EUSEBIO T. PACOLOR, Ph. D. Vice President for Academic Affairs

Approved: SIMON P. BABALCON JR., Ph. D. University President

Form A3 Republic of the Philippines

SAMAR STATE UNIVERSITY


Catbalogan City, Samar Tel. No. (055) 251-2139; Fax. No. (055)543-8394 Website: http://www.ssu.edu.ph

CERTIFICATION
DENNIS G. COSMOD
(Name of Applicant)

This is to certify that

of SAMAR

(Name of home/sending Institution)

STATE UNIVERSITY is recommended for a Scholarship Grant under the


Faculty Development Program II by the Commission on Higher Education with the degree of

MASTER

(Degree applying for)

OF

PHYSICS

to

enroll

at

UNIVERSITY OF SAN CARLOS starting SECOND Academic Year 2010(Delivering Institution) (Semester)

2011 until SECOND Academic Year 2012-2013.


(Semester)

DENNIS G. COSMOD SIMON P. BABALCON JR., Ph. D.

September 17, 2010 September 17, 2010

Note: This must be submitted using the letterhead of the home/sending institution

Form A4 Republic of the Philippines

SAMAR STATE UNIVERSITY


Catbalogan City, Samar Tel. No. (055) 251-2139; Fax. No. (055)543-8394 Website: http://www.ssu.edu.ph

Rehiring Agreement
(For Non-Permanent Faculty) The SAMAR STATE UNIVERSITY, with present postal address at BRGY. GUINDAPUNAN, CATBALOGAN CITY, SAMAR 6700 and duly represented by its president/head DR. SIMON P. BABALCON JR., hereinafter referred to as Sending Higher Education Institution (SHEI); and Mr. /Mrs. DENNIS G. COSMOD, of legal age, Filipino, a

probationary/contractual/temporary faculty of said SHEI, a resident of 940 BRGY. MERCEDES, CATBALOGAN CITY, SAMAR, hereinafter referred to as Applicant. And in consideration of the support of the CHED through the Faculty Development II (FDP II) do hereby knowingly agree to the following terms and conditions to wit: THAT, the SHEI shall give the Applicant a Permanent/Regular Appointment to his/her teaching position, if legally possible, or rehire the latter to return service after the completion of his/her MASTER OF PHYSICS degree; and THAT, the Applicant shall complete the academic degree within the specified period. WHEREFOR, both parties, will signify that the above terms and conditions have been discussed to them and that they fully understand and agree to all the terms thereof. Signed this 17th day of September, 2010 in the City/Municipality of Catbalogan, Philippines.

SIMON P. BABALCON JR., Ph. D.


Signature Over Printed Name of School Head

Signature Over Printed Name of Applicant

DENNIS G. COSMOD

SIGNED IN THE WITNESS OF:

MELDRITO B. VALLES, Ph. D.

EUSEBIO T. PACOLOR, Ph. D.

ACKNOWLEDGMENT REPUBLIC OF THE PHILIPPINES) CITY OF CATBALOGAN) s.s BEFORE ME, a Notary Public for and in CATBALOGAN CITY, SAMAR on SEPTEMBER 17, 2010, personally appeared the following to wit:

NAME DR. SIMON P. BABALCON JR. (Head, Sending HEI) MR. DENNIS G. COSMOD (Faculty Applicant)

Valid ID/Passport No.

Date & Place Issued

KNOWN TO ME and to be the same persons who executed the foregoing Rehiring Agreement consisting of 2 pages including this page and acknowledgment to me that the same is their own free act and deed. WITNESS MY HAND AND SEAL on this 17th day of September 2010.

Notary Public Doc. No. ____________ Page No. ___________ Book No. __________ Series No. _________

SAMAR STATE UNIVERSITY


Catbalogan City, Samar Tel. No. (055) 251-2139; Fax. No. (055)543-8394 Website: http://www.ssu.edu.ph

Republic of the Philippines

CERTIFICATION
This is to certify that Samar State University offers the following curricular programs: College of Graduate Studies
1. Master of Arts (English, Filipino, Guidance and Counseling, Home Economics, Physical Education, Non-Formal Education) 2. Master of Arts in Education 3. Master of Arts in Elementary Education 4. Master of Arts in Teaching (Chemistry, Mathematics, Physics) 5. Master in Engineering (Construction Engineering and Management, Engineering Management, Water Resource Engineering and Management) 6. Master of Public Management 7. Master of Technician Education 8. Doctor of Philosophy (Educational Philosophy) 9. Doctor of Philosophy (Technology Management) 10. Doctor in Management (Human Resource Management) College of Arts and Sciences 1. Bachelor of Science in Information Technology (BSInfoTech) 2. Bachelor of Science in Information System (BSIS) 3. Bachelor of Science in Applied Statistics (BSAS) 4. Bachelor of Science in Psychology (BSPyscho)

College of Education
1. Bachelor of Secondary Education (BSEd) (Physics, Chemistry, Mathematics, Physical Education, THE) 2. Bachelor of Elementary Education (BEEd) 3. Bachelor of Science of Technician Education (BSTE) 4. Diploma in Teaching (DT) College of Engineering 1. Bachelor of Science in Civil Engineering (BSCE) 2. Bachelor of Science in Electrical Engineering (BSEE) 3. Bachelor of Science in Computer Engineering (BSCoE) 4. Bachelor of Science in Electronics and Communication Engineering (BSECE) College of Industrial Technology 1. Bachelor of Science in Industrial Technology (BSIT) 2. Bachelor of Technology (BT) 3. Bachelor of Industrial Technology (BITech) 4. Bachelor of Mechanical Technology (BMT) 5. Competency Based Vocational Education (CBVE)

College of Nursing 1. Bachelor of Science in Nursing (BSN) SSU MERCEDES CAMPUS College of Fisheries and Marine Sciences 1. Bachelor of Sciences in Fisheries 2. Bachelor in Secondary Education (Fishery Education) 3. Bachelor of Science in Marine Engineering 4. Bachelor of Science in Marine Biology SSU PARANAS CAMPUS 1. Bachelor of Science in Industrial Education (Automotive, Electrical, Drafting, Garments, and Foods Technology) 2. Bachelor of Science in Elementary Education 3. Bachelor of Science in Education

SSU BASEY CAMPUS 1. Bachelor of Elementary Education 2. Bachelor of Science in Industrial Technology (Foods, Electronics, Garments, and Electrical Technology)

Certified by: EUSEBIO T. PACOLOR, Ph. D. Vice President for Academic Affairs

SAMAR STATE UNIVERSITY


Catbalogan City, Samar Tel. No. (055) 251-2139; Fax. No. (055)543-8394 Website: http://www.ssu.edu.ph

Republic of the Philippines

CERTIFICATION
This is to certify that Samar State University has the following number of enrollees by College for First Semester School Year 2010-2011. SSU Main Campus College of Graduate Studies College of Arts and Sciences College of Education College of Engineering College of Industrial Technology College of Nursing SSU MERCEDES CAMPUS College of Fisheries and Marine Sciences SSU PARANAS CAMPUS SSU BASEY CAMPUS TOTAL SSU ENROLMENT 742 581 508 1227 216

Certified by: MRS. ERLINDA U. BABALCON University Registrar

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