Republic of the Philippines

DAVAO ORIENTAL STATE COLLEGE OF SCIENCE AND TECHNOLOGY

Guang-guang, Dahican, 8200 City of Mati, Davao Oriental
Tel/Fax: (087) 3883-195/Website: www.doscst.edu.ph

OFF-CAMPUS ACTIVITY
FORM 1: ACTIVITY PERMIT

Date of Filling: __________

Student/s Applicant/s: _________________________________________________________

Activity: ___________________________________________________________________
Place/s to be visited: __________________________________________________________
Activity Duration: Total No. of Days: _____________
Departure Date: ______________
Return Date: _________________
DOSCST Personnel Chaperon:
Name: ______________________ Signature: ___________________
Names of Other People Accompanying the Trip: ___________________________________
Statement on the role/s of others accompanying the trip relative to the activity:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

Recommending Approval:

MRS. LANIE B. LAUREANO, MIT ENGR. JEAN C. EBALLE

Program Head BSIT Dean ICE

PROF. JIHAN A. LABRADOR DR. SATURNINO E. DALAGAN

Head OSA Director DSS

DR. ROMEO G. REDULLA DR. JOY M. SORROSA

Director for Instruction Vice President for Academic Affairs

Approved:

DR. EDITO B. SUMILE

SUC President III