Department of Education: Deped Region X - Northern Mindanao

Republic of the Philippines
January –December 2020

DEPARTMENT OF EDUCATION January 2020
DepEd Region X – Northern Mindanao January 2021
QA-SH-584
SENIOR HIGH SCHOOL – QUALITATIVE EVALUATION PROCESSING SHEET
Region/Division: ______________________________ School/Organization: _________________________________________________

Contact Person: ______________________________ Complete Address of School: ___________________________________________
Designation: ______________________________ __________________________________________________________________
Date of Application: _____________________________ Cellphone Number/E-mail Address: _____________________________________
Date of Application: _____________________________ __________________________________________________________________
SY of Intended Operation: ________________________ Category:___________________________________________________________
Remarks:
Category A - Private schools, which have been granted at least level II accreditation by any of the accrediting agencies under the Federation
of Accrediting Agencies in the Philippines (FAAP).
Category B - Non-DepEd Schools, which have been issued a permit or government recognition by Commission on Higher Education (CHED)
to offer any higher education program.
Category C- Private schools, which have been granted recognition by the DepEd to offer secondary education (Year I-IV/Grades 7 to 10).
Category D - Non-DepEd schools, which have been issued a permit or recognition by Technical Education and Skills
Development Authority (TESDA) to offer any training course, and other individuals, corporations,
foundations or organization duly recognized by the Securities and Exchange Commission (SEC).
REQUIREMENTS
REMARKS
ITEM / or x Document Evaluation Ocular Inspection
Letter of Intent
Board Resolution certified by the secretary and approved by the Board of Directors/Board of Trustees
a. Purpose
b. School year of intended
Operation
c. SHS Curriculum for the
track/s and strand/s to
be offered
REMARKS
Page 1 of 6
DEPARTMENT OF EDUCATION
DepEd Region X – Northern Mindanao
/ or X Document Evaluation Ocular Inspection

ITEM
Certificate of Recognition of any of the following:
a. Secondary Education
Program-DepEd
b. Training Program –
TESDA
c. Higher Education
Program - CHED
d. Others:
*FAAP recognized
accrediting agencies
*Asia Pacific
Accreditation and
Certification
Commission (APACC)
Proposed tuition & other
fees
Proposed School Calendar
Proposed list of academic and non-academic personnel
a qualifications
b Job descriptions
c teaching load
d number of working
hours per week
e certification from
recognized national/
International agencies
(TESDA,ABA and others)
Page 2 of 6
Academic Track:
_____________ Humanities and Social Sciences (HUMSS) Strand
_____________ Science, Technology, Engineering and Mathematics (STEM) Strand
_____________ Accountancy, Business and Management (ABM) Strand
_____________ General Academic Strand (GAS)
Technical-Vocational-Livelihood Track:
AFA __________________________________________________________________________
IA __________________________________________________________________________
HE __________________________________________________________________________
ICT __________________________________________________________________________
Arts and Design Track :
Performing Arts _______________________________________________________
Arts Production _______________________________________________________

Sports Track
Minimum program requirements for the SHS tracks/strands:

a. Instructional rooms
b. Laboratories
b.1 Computer
b.2Science (for STEM
minimum of 3 labs
b.3 Workshop
room/studios
c. Athletic facilities
d. _Learner’s Resource
center of library
e. Internet facilities
f. Ancillary services
Page 3 of 6
A copy of Memorandum/Memoranda of Agreement/Memorandum of Understanding for partnership arrangements relative to the SHS Program
Implementation. These arrangements may include:
a. engagement of
stakeholders in the
localization of the
curriculum
b. Workshop immersion
c. Apprenticeship
d. Research
e. provision of equipment
and laboratories,
workshops and other
facilities
f. organization of career
guidance and youth
formation activities.
g. Others
Additional requirements for Category D:
Articles of Incorporation &
by-laws for private schools
only
Documents of ownership
of school sites under the
name of the school, or
deed of usufruct
Proposed annual budget
and annual expenditures
Reviewed by: Remarks: _____ Complete
_____ Incomplete_____________________________________
________________________ _____________________________________
DO SHS Evaluator/Coordinator
Date: _______________________
Page 4 of 6
Remarks:
Recommended for Ocular Inspection Tracks/Strands/Specializations: _______________________________________
_______________________________________
With Deficiencies
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
Processed by:
________________________
DO SHS Evaluator/Coordinator
(Signature over Printed Name)
Date of Ocular Inspection: _______
Recommended Action:
___ Issuance of SHS Government Permit (Indicate track/strand and specializations for Technical-Vocational-Livelihood track)
(specify) ___________________________________________________________________________________________________
__________________________________________________________________________________________________________
___ Defer Issuance of Government Permit upon completion of K to 12 SHS Program requirements
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
For revalidation on: _________________
_____________________ _____________________
RO Evaluator RO Evaluator
(Signature over Printed Name) (Signature over Printed Name
Date of Ocular Inspection: ____________
Page 5 of 6
Revalidated on: _______________

Remarks:
_____ Recommended for Issuance of Government Permit (Indicate track/strand and specializations for TVL track)
(Specify)________________________________________________________________________________________________
_______________________________________________________________________________________________________
_____ Recommended for Deferment
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
Conforme:
___________________ ____________________ ___________________
DO Evaluator RO Evaluator RO Evaluator
(Signature over Printed Name) (Signature over Printed Name) (Signature over Printed Name)
_______________________
School Head
E-mail Ad: _______________________________________________
Contact/Cellphone Number: ________________________________
Date: ___________________________________________________
Action Taken:
_____ Issuance of Government Permit (Indicate track/strand and specializations for Technical-Vocational-Livelihood track)
_______________________________________________________________________________________________________
_____ Recommend to applicant to defer operation upon completion of K to 12 SHS Program requirements
_____ Others (please specify)
APPROVED:
ROGELIO C. EVANGELISTA
Chief, Quality Assurance Division DR. ARTURO B. BAYOCOT, CESO III
Regional Director
Date: _______________________________
Page 6 of 6

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Republic of the Philippines

January –December 2020

Region/Division: School/Organization: ___________________

/ or X Document Evaluation Ocular Inspection

Arts Production _______________________________________________________

Minimum program requirements for the SHS tracks/strands:

Date of Ocular Inspection: _______

For revalidation on: _________________

Revalidated on: _______________

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