Republic of the Philippines

Department of Education
Region X- Northern Mindanao
LANAO DEL NORTE DIVISION
Gov. A. Quibranza Prov’l. Gov’t. Compound
Pigcarangan, Tubod, Lanao Del Norte
E-mail Address: deped_ldn@yahoo.com

APPLICATION FOR PERMIT TO STUDY

Name: MOSLIMAH IMAM ALI Permit No. _________________

School: POONAPIAGAPO INTEGRATED SCHOOL Position: TEACHER-1
District: POONAPIAGAPO DISTRICT Date: APRIL 22, 2019
College/University: ST. MICHAEL’S COLLEGE Address: POONAPIAGAPO LDN.
Course Applied for: MASTER OF ARTS IN EDUCATION, MAJOR IN FILIPINO
Academic Year: 2018-2019 Quarter: Summer Class

CODE DESCRIPTION UNITS DAY TIME

Fil-215 Panunuring Pampanitikan 3 M-S 01:00P03:00P

Fil-219 Wika, Kultura at Lipunan 3 SaA 08:00A-10:00A
Fil-212 Mga Stratehiyasa Pagtuturo ng Wika 3 M-S 08:00A-10:00A

Credits or Units towards - BSE MA Ed.D / Ph.D

Total Number of units previously: _______ _______ _______________
Number of units to be earned this Quarter /Semester /Summer: 9 UNITS
Total units earned: Date completed:

I understand that the regulations on the outside study of teachers are intended primarily
to safeguard and to maintain the efficiency of my service. I further understand that in the sound
discretion of the Head of Agency, this permission maybe revoke when found adversely affect
my performance. Finally, I commit to submit to the Head of Agency through my immediate
supervisor the rating I obtained every end of the semester.

MOSLIMAH I ALI
Signature Over Printed Name

Recommending Approval:

SAIMAH P. SAMPORNA
School Principal

APPROVED:
ROY ANGELO E. GAZO, CESO V
Schools Division Superintendent