Application To Study Updated - Template DepEd

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APPLICATION FOR PERMISSION TO STUDY

Name of Applicant:____________________ Position: ____________


Civil Service Eligibility: __________________ Civil Status: _ ______
Name of School where Employed: _________________ Barrio: ______________________
Municipality: _________________________________ Perm/Prov’l: _________________
Distance in km from the official station to college where enrolled: _____________________
________________________________________________________________
(Name and Location of college where applicant wished to enroll)
Contact No.: ____________________________
Course applied for: _____________________________________________________
Academic Year: ____________________________Quart/Sem/Summer: ___________
Course to be taken this term and schedule:
COURSE DAYS OF THE WEEK HOURS OF THE WEEK
_______________________ ______________________ ______________________
_______________________ ______________________ ______________________
_______________________ ______________________ ______________________
_______________________ ______________________ ______________________
Credits or Units COURSE MA Ed.D/Ph.D
Total number of units previously earned _____________ ______________
________________
No. of units to be earned this Qtr/Sem/Summer: _____________ ______________
________________
I hereby certify that I have carefully read all the provisions on the next page of this form, which I
am bound to observe strictly. I understand that permit to study is intended to primarily safeguard the
health of the teacher/personnel as well as maintain the efficiency in the service. I also understand that
when the Schools Division Superintendent is notified on the study. Shall this adversely affect my
efficiency as a teacher/personnel, this permission to study may be revoked accordingly.

__________________________
(Signature of Applicant)
Date Submitted: ________________________
Noted by:

_____________________________
School Head/Principal

Recommending Approval:

________________________
Assistant Schools Division Superintendent

Approved by:

________________________
Schools Division Superintendent

Note:
This permit expires on/at the end of _______________________________to study
DATE: ____________________________
PERMIT NO: _______________________
TERM: ___________________________
(Should be accomplished in triplicate copies)
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APPLICATION FOR PERMISSION TO STUDY

INSTRUCTION

1. Application for permission to study in three (3) copies must be submitted to the office of the SDS
not later than one (1) month before the start of the actual classes. THE TEACHERS MUST FILE
THE REQUEST BEFORE ENROLLING FOR THE FIRST TIME IN ANY SCHOOL COLLEGE OR
UNIVERSITY.
2. The teacher applicant’s performance must be “ABOVE AVERAGE” or higher.
3. The permission is given until the applicant completes the curriculum towards a degree.
4. A certification from the head of the school or college where the teacher is enrolled and the
subject already completed and those shall be all certified by the registrar of the private school.
5. A teacher who is about to finish a course of who has started a course as well as the subject
already completed and those to be completed and those to be enrolled shall be all certified by
the registrar of the private school.
6. After each semester every teacher granted permission to study should submit to the
superintendent’s office, through channels, a certified true copy of the report on the ratings
obtained in the course which he took during the semester, including the number of units earned.
In addition, as soon as he/she finished the curriculum towards the degree he/she should submit
a complete set of his/her transcript of grades, records and special order to the superintendent.
7. The maximum study load of nine (9) units per semester should be strictly observed. A teacher
who is a candidate for graduation may be allowed to carry from one (1) to three (3) units more
than nine (9) units authorized provided that those units are the last units the teacher need to
enable him to graduate. No exception will be given where the teacher does not fall under the
above stated condition.
8. The college, school, or university in which the teacher contemplates enrolling should be
accessible to his official station so he will not be unduly compelled to hurry there from his station
in order to arrive at his class on time. The teacher should attend his outside study not earlier
than thirty (30) minutes after the afternoon session in the public school.
9. The immediate supervisor or supervisor shall be held strictly responsible for any undue delay in
forwarding the application to the superintendent, if the application to the superintendent has
been filed on time.

_____________________________________________________
(Name and Location of College where the applicants wishes to enroll)

Contact No.: ____________________________

CERTIFICATION

TO WHOM IT MAY CONCERN:

This is to certify that ___________________________________________________, Public School


Teacher,

Is seeking admission in this college to ______________________________________________ following


(Course)
Subject/s offered this ________________________.
(Semester SY/ summer SY)
COURSE DAYS OF THE WEEK HOURS OF THE DAY

1. _____________________ ________________________ _______________________


2. _____________________ ________________________ _______________________
3. _____________________ ________________________ _______________________
4. _____________________ ________________________ _______________________
5. _____________________ ________________________ _______________________

Issued this day _________________ of ___________, _____.

________________________________ ________________________________
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College Dean College’s Registrar

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