OFFICE OF STUDENT AFFAIRS

University of the Philippines Visayas

Miagao, Iloilo

APPLICATION FORM FOR EXTRA-CURRICULAR ACTIVITIES*

__________________________
Date Filed

A. APPLICATION TO HOLD THE ACTIVITY

1) Applicant Organization: __________________________________________________________________________
2) Activity: ______________________________________________________________________________________
3) Purpose: ______________________________________________________________________________________
4) Date of Activity: _______________________________

5) Time: From: ______________ To: ________________

6: Number of Participants: ___________________________________________________________________________

7) Expense per participant, if any (certified by adviser): ___________________________________________________
8) Submitted by: _________________________________
Contact No: ___________________________________

9) Confirmed by: ________________________________

(Signature of Faculty Adviser)

RECOMMENDATION
For College-Based Student Organizations
__________________________________
COSAW/STUDENT RELATIONS OFFICER

For University-Wide Student Organizations

__________________________________
SOA IN-CHARGE, OSA

Approved:
Approved:
__________________________________
COLLEGE DEAN

Noted:

__________________________________
OSA DIRECTOR

__________________________________
OSA DIRECTOR

Remarks:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
______________________________________________________________________________________________

B. APPLICATION FOR THE USE OF FACILITIES

10) Venue of Activity: _________________________________ Approved: ___________________________
11) Equipment and Personnel Services Requested
(if applicable)
_____________________________________
_____________________________________
_____________________________________
_____________________________________

Number
_______
_______
_______
_______

Action by Office
____________________________
____________________________
____________________________
____________________________

*Permit should be filed ten (10) working days before the activity if there is a need for equipment and
personnel services; seven (7) working days before the date of the activity for the use of the Audio-Visual
Rooms, Little Theater and UPV Auditorium; and five (5) working days for the use of other roofed spaces.

CONFORME
The undersigned hereby agrees to pay (if applicable) an amount equivalent to
the total use of facilities upon approval of this application. It is further agreed
that all charges set forth and the following specific guidelines shall govern the use
of UPV facilities:
1) All University technical equipment, lights and other similar facilities shall be
operated by University personnel ONLY or, in highly exceptional cases, by nonUPV duly licensed authorized technicians.
2) Users of University facilities shall be responsible for the cleanliness and
orderliness of the premises after their use, as well as for the care and
protection of facilities from any damage. An amount, to be determined by the
UPV Administration, shall be charged to the users for the repair or replacement
of equipment/facilities or parts of the same destroyed due to their irresponsible
use.
3) There will be additional electricity charges (if applicable) for additional
equipment/facilities which shall be determined by the CDMO.
4) The University reserves the right to refuse the use of its equipment/facilities
which shall be determined by the ASO.
5) The use of nails, paste, tape, etc., that destroys or defaces walls, floors or any
other part of the building and condition of the equipment/facilities is prohibited.
6) The use of inflammable or explosive materials is strictly prohibited.
7) Smoking is not allowed in the lecture halls/rooms.
8) The highest possible standard of professional behavior is to be strictly observed
at all times in the use of University premises and facilities.
I hereby declare that I have read and fully understood the terms and
conditions specified in this agreement.

_______________________
Signature Over Printed Name
of Requestor
NOTED:
_______________________
Signature Over Printed Name
of Faculty Adviser
cc:

1) Office of Student Affairs

3) Security Office

2) Office In-Charge of Facilities Requested

4) Requestor