Reference No.: OMSC-Form-CAO-01-A Effectivity Date: November 06, 2017 Revision No.

: 00

Republic of the Philippines

OCCIDENTAL MINDORO STATE COLLEGE
Admin Bldg., Labangan Poblacion, SJOM
Website: www.omsc.edu.ph Email Address: omsc_9747@yahoo.com
Tele/Fax: (043) 457-0231

Date (mm/dd/yr): July 27, 2018

Request Form for Travel or Training

Participants: ARTEMIO M. GONZALES JR Contact Number: 09060780937

College/Office/Campus: RDE/ MIDWIFERY

Purpose of Travel / Training: To present paper at the 2nd Sigma Asia Region Conference
Venue / Name of Training: Bethel House Hotel, Dumaguete City/ 2nd Sigma Asia Region Conference
Sponsoring Agency:_Sigma Theta Tau Honor Society for Nursing

Departure Date: August 19, 2018 Arrival Date: August 23, 2018 Training Duration Date: August 20-21, 2018

To Attend:
Attachments:
□ Training/Conference □ Meeting/Consultation
□ Estimated Budget for Travel
□ Extension □ Research Presentation/Training
□ Travel Invitation
□ Others: ______________

Budget Estimate: Php 11, 150.00

Funding Source / Code ______________________________________________________

Requested travel / training is necessary, lawful and incurred under my direct supervision as requesting party.

SUSANITA G. LUMBO, PhD ELBERT C. EDANIOL, EdD

Director of Research ____________ Vice President for Academic Affairs
Requested By: (Signature over Printed Name and Designation) Signature of Immediate Supervisor

Action Taken SUC President Office: Approved Travel Inclusion:

□ Approved □ Registration Fee

□ Disapproved Remarks: ___________________________ □ Accommodation
□ Transportation Expense
MARLYN G. NIELO, PhD □ Others: _____________________________
SUC PRESIDENT II

Monitoring/Notification of result:

Date Received: _____________________ □ Recorded Remarks:

CAO Office Reference Number: _____________________ _______________________________
Date Forwarded to the SUC President: ______________
Date Returned to the Requester: ___________________ MA. PAZ FATIMA D. PALMARES, CPA
CHIEF ADMINISTRATIVE OFFICER

cc: participants
program head
VPAA/VPAFSS
concerned Officials