Republic of the Philippines
DEPARTMENT OF EDUCATION
CRITERIA
1. The School must have
a Principal position per
latest PSIPOP and at
least twenty (20)
teachers.
2. The school must have a.
an agency code and
designated/appointed b.
financial staff
(Bookkeeper and c.
Disbursing Officer); and
capability to comply
with the submission of
financial report to
oversight agencies d.
such as COA, DBM,
NEDA, Senate, House
of Representatives, etc.
3. The proposed school
must have at least 100
pupils/students
composed of one or
more grade levels
R E G I O N III
SCHOOLS DIVISION OFFICE OF BATAAN
Website: www.depedbataan.com | email: bataan@deped.gov.ph | FB Page: https://www.facebook.com/DepedBataan
Telephone / Fax : 047-2372102 | Address: Bataan Provincial Capitol Compound, Balanga City 2100
APPLICATION FOR CONVERSION OF A HIGH SCHOOL CLASSIFIED AS
NON-IMPLEMENTING UNIT INTO A HIGH SCHOOL CLASSIFIED AS IMPLEMENTING UNIT SCHOOL
EVALUATION SHEET
REMARKS
REQUIRED DOCUMENTS PER EVALUATION (PASSED OR FAILED/
Pls. state reason, if failed)
School’s latest and updated Name of School : _________________________________________________________________
PSIPOP Per PSIPOP for FY ____________:
Position Title No. of Position
E.g. Principal I
Teacher III
Teacher II
Teacher I
TOTAL
Approval of School’s Agency a. Agency Code Number : _________________________________________________________
Code by DBM Approved by : _________________________________________________________
Designation documents duly Position/Designantion : _________________________________________________________
signed by the School Head Office : _________________________________________________________
Certificates of Training Date : _________________________________________________________
attended by the
designated/appointed
financial staff related to
financial management
Certification of the school
head as to the capability of
the school to comply with the
submission of financial
reports to oversight agencies
such as COA, DBM, NEDA,
House of Representatives,
etc.
List of prospective enrollees No. of Prospective Enrollees:
per grade level, including their Grade Level No. of Enrollees
names, ages, addresses 1
and/or school where they are 2
currently or were enrolled 3
4
1
 Republic of the Philippines
DEPARTMENT OF EDUCATION
R E G I O N III
SCHOOLS DIVISION OFFICE OF BATAAN
Website: www.depedbataan.com | email: bataan@deped.gov.ph | FB Page: https://www.facebook.com/DepedBataan
Telephone / Fax : 047-2372102 | Address: Bataan Provincial Capitol Compound, Balanga City 2100

In case the Justification by the SDS on the 5

aforementioned need to establish a school, if 6
criterion is not met, the necessary. 7
SDS shall make 8
necessary justification. 9
10

List contains complete information as to the:

PARTICULARS YES NO
1. Names of pupils/students
2. Ages
3. Addresses and/or school where currently or were enrolled
4. Prospective enrollees are bonafide residents of the
barangay/municipality

Justification Signed By : _________________________________________________________________

Position/Designation : _________________________________________________________________
Date : _________________________________________________________________

4. There is no private high a. Certification from the a. Certification Signed By : ___________________________________________________________

school participating in
the Government
Assistance to Students
and Teachers in Private
Education (GASTPE)
Program of DepEd; or
the GASTPE recipient
school(s) has reached
its allocation or number
of available slots
b.
In cases where the
aforementioned criteria
is not met, the SDS
shall make the
necessary justification.
SDS that no private high
school within the
Municipality/City is
participating in the
GASTPE Program of
DepEd, or the GASTPE
participating high school
has reached its
allocation or number of
available slots; OR
Justification by the SDS
on the need to establish
a public school to cater
to the elementary school
graduates/students who
cannot afford to enroll in
a private high school
Position/Designation : ___________________________________________________________
Date : ___________________________________________________________
GASTPE Participating High School(s)
Name of School No. of Slots Allocated No. of Slots Filled Remarks
1.
2.
b. Justification, if any, duly signed : _______________________________________
Position/Designation : _______________________________________
Reason(s) : _______________________________________
______________________________________________________________________________
______________________________________________________________________________

5. The proposed school to a. Map, preferably drawn to

be established is not
within the 2-km and 1
km radius from any
existing public school in
scale, showing the a. Map shows the distances of the proposed from the existing school? YES ________ NO ________
distances of the existing
schools within the Name of Nearest School Distance to the Proposed Address
catchment area of the School (in km)
2

rural and urban areas,
respectively. However,
this limitation may be
waived the 2 or 1 km
radius, as the case may
be, can no longer b.
accommodate students
seeking admission, is
geographically
inaccessible, or
necessary in the best
interest of education as
justified by the SDS.
c.
6. Existence and a.
availability of a school
site 5,000 square
meters or one half (1/2)
hectare for rural areas;
2,500 square meters
for highly urbanized
cities.
In cases where there is
difficulty in meeting the
aforementioned
guidelines with respect b.
to a standard school
site, the SDS shall
make the necessary
justification.
7. School site must not be
a high-risk area (natural
or man-made). The
land characteristics of
SCHOOLS DIVISION OFFICE OF BATAAN
Website: www.depedbataan.com | email: bataan@deped.gov.ph | FB Page: https://www.facebook.com/DepedBataan
Telephone / Fax : 047-2372102 | Address: Bataan Provincial Capitol Compound, Balanga City 2100
proposed new school,
duly certified by the
Municipal/City Engineer.
Certification from the
Municipal/City Engineer
that proposed school is
not within the 2-km
radius (for rural areas)
or 1 km radius (for urban
areas) from any existing
public elementary/high
school;
- OR -
Justification by the SDS
for the waiver on the 2 or
1 km radius requirement
Any document such as
but not limited to Deed
of Donation, Deed of
Sale or Contract of
Usufruct for 50 years
executed in favor of
DepEd; Original
Certificate of Title (OCT)
or Transfer Certificate of
Title (TCT) in the name
of DepEd, reflecting the
size and boundaries of
the school site; OR
Justification from the
SDS in case the
required size of school
site cannot be met.
Clearance/permit from
the provincial Mines and
Geosciences Bureau
(MGB) and the Regional
Republic of the Philippines
DEPARTMENT OF EDUCATION
R E G I O N III
1.
2
3
b. Certification Signed by : _____________________________________________________
Position/Designation : _____________________________________________________
Office : _____________________________________________________
c. Justification Signed by : ____________________________________________________
Position/Designation : ____________________________________________________
Reason(s) : ____________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
a. Document Submitted : e.g. Deed of Donation________________________________
In favor or in the name of DepEd : YES _________ NO _________
Address/Location : __________________________________________________
Sized based on boundaries of : __________________________________________________
proposed school site (in square
meters)
b. Justification, if any, duly signed by : _______________________________________________
Position/Designation : _______________________________________________
Reason(s) : _______________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
a. Clearance/permit from provincial MGB (must be updated)
Signed By : _______________________________________________
Position/Designation : _______________________________________________
Date : _______________________________________________
3

which include good
elevation to avoid
flooding and soil
erosion, good drainage
system, and
safe/potable water
supply/
8. Must have at least two a.
(2) classrooms for the
initial operation of the
school. Classrooms
built/to be built must be b.
in accordance with
existing DepEd
standards.
All public elementary
and high schools shall
adopt the standard 7m c.
x 9m classroom
dimension regardless
of its class size.
d.
e.
f.
SCHOOLS DIVISION OFFICE OF BATAAN
Website: www.depedbataan.com | email: bataan@deped.gov.ph | FB Page: https://www.facebook.com/DepedBataan
Telephone / Fax : 047-2372102 | Address: Bataan Provincial Capitol Compound, Balanga City 2100
Office (RO) of the
Department of
Environment and Natural b.
Resources (DENR)
stating that the
Proposed school site is
not a high-risk are.
School site development a.
plan
School Building plan
indicating the number b.
and technical
specifications of the
classrooms to be built
School building design,
duly approved by DepEd
Education Facilities
Division, Administrative
Service
School Building Permit c.
issued by the
Municipal/City Engineer
Bureau of Fire d.
Protection (BFP)
Certificate
Inspection Report from e.
Division In-Charge of
Education Facilities
Section, in case
classrooms are already
constructed
f.
Republic of the Philippines
DEPARTMENT OF EDUCATION
R E G I O N III
Certification from RO-DENR (must be updated)
Signed By : _______________________________________________
Position/Designation : _______________________________________________
Date : _______________________________________________
Declared as safe or not a high risk area? YES ________ NO _________
School Site Devt. Plan Prepared By : __________________________________________
Position/Designation : __________________________________________
Office : __________________________________________
Date Prepared : __________________________________________
School Building Plan Prepared By : __________________________________________
Position/Designation : __________________________________________
Office : __________________________________________
Date Prepared : __________________________________________
No. of Classrooms to be built : __________________________________________
With attached technical specifications? : YES _______ NO _______
Proposed classrooms built/to be built are compliant with DepEd standards? YES ______ NO _______
If no, pls. state the classroom dimension/other deviations : ___________________________________
School Building Design Approved By : __________________________________________
Position/Designation : __________________________________________
Office : __________________________________________
Date Approved : __________________________________________
School Building Permit Isssued By : __________________________________________
Position/Designation : __________________________________________
Office : __________________________________________
Date Issued : __________________________________________
Bureau of Fire Protection Certificate Issued By : ________________________________________
Position/Designation : __________________________________________
Office : __________________________________________
Date Issued : __________________________________________
Inspection Report Issued By : __________________________________________
Position/Designation : __________________________________________
Office : __________________________________________
Date Issued : __________________________________________
4

9. The LGU or DepEd a.
Division Office has
adequate funds for its
initial operation,
payment for teachers’
salaries, allowances
and other benefits,
maintenance and other
operating expenses.
Republic of the Philippines
DEPARTMENT OF EDUCATION
R E G I O N III
SCHOOLS DIVISION OFFICE OF BATAAN
Website: www.depedbataan.com | email: bataan@deped.gov.ph | FB Page: https://www.facebook.com/DepedBataan
Telephone / Fax : 047-2372102 | Address: Bataan Provincial Capitol Compound, Balanga City 2100
Duly notarized MOA by a. Signatories of Contracting Parties : __________________________________________
and between DepEd, 1. For the DepEd
represented by the Signed By : __________________________________________
Municipal/City Mayor or Position/Designation : __________________________________________
Provincial Governor, as 2. For the LGU
the case may be, where Signed By : __________________________________________
the LGU shall provide Position/Designation : __________________________________________
funds for, among others, Date Notarized : __________________________________________
the following: (Refer to
Annex E-1 for the LGU Support specified in the MOA or SB Resolution
sample template)
Partculars Amount
1. Construction of the
a. Construction of the new school building(s) PhP
new school
building(s); b. Procurement of educational facilities, furniture, instructional
materials.
2. Procurement of c. Operation and maintenance for at least five (5) years or until such
educational time when funds for the purpose are incorporated in the budget
facilities, furniture d. Salaries of teaching and non-teaching personnel, preferably at par
and instructional with national salary rates
materials; e. Other LGU support
TOTAL PhP
3. Operation and
maintenance for at
least five (5) years
or until such time
when funds for the
purpose are Availability of Funds Certified by : ___________________________________________
incorporated in the Position/Designation : __________________________________________
national budget; Office : __________________________________________
and Date Approved : __________________________________________
4. Salaries of
teaching and non-
teaching personnel, Sangguniang Bayan/Panglungsod Resolution
preferably at par Prepared by
with the national Position/Designation : __________________________________________
salary rates. Date Signed : __________________________________________
The MOA must be
supported by the
Sangguniang
Bayan/Panglalawigan/ b. Certification Signed by : __________________________________________
5

b.
c.
EVALUATED BY DIVISION REVIEW AND EVALUATION COMMITTEE (DREC):
ANDRES C. MATAWARAN, Ed.D.
Signature Over Printed Name
EPS-SGOD
Position/Designation
JOSEFINA T. NAGUIT
Signature Over Printed Name
PLANNING OFFICER III
Position/Designation
Republic of the Philippines
DEPARTMENT OF EDUCATION
R E G I O N III
SCHOOLS DIVISION OFFICE OF BATAAN
Website: www.depedbataan.com | email: bataan@deped.gov.ph | FB Page: https://www.facebook.com/DepedBataan
Telephone / Fax : 047-2372102 | Address: Bataan Provincial Capitol Compound, Balanga City 2100
Panglungsod Resolution Position/Designation : __________________________________________
for the purpose. Office : __________________________________________
Date : __________________________________________
Certification from the Availability of Funds Certified by : __________________________________________
schools Division Position/Designation : __________________________________________
Superintendent that the Office : __________________________________________
Schools Division Office Date Approved : __________________________________________
has sufficient fund to
cover resulting No. of Teachers to be Borrowed, if any : _________________________________________
expenses. No. of Non-Teaching Personnel to be Borrowed,
if any : _________________________________________
List of teaching and non-
teaching personnel to be List contains Complete Information as to:
borrowed from the
existing nearby PARTICULARS YES NO
school(s), duly identified
by the respective Item 1. Position Titles
Numbers per PSIPOP 2. Item Number per Latest PSIPOP
and name of school, if
any. 3. Name of Lending School
RECOMMENDED BY:
RAMON C. PEREZ ENGR. MERCK BRYAN GRAGASIN JESSIE D. FERRER, CESO V
Signature Over Printed Name Signature Over Printed Name Signature Over Printed Name
SGOD CHIEF ENGINEER III SCHOOLS DIVISION SUPERINTENDENT
Position/Designation Position/Designation Position/Designation
HERMIE G. DURAN
Signature Over Printed Name
EPS II-M&E
Position/Designation
6
 Republic of the Philippines
DEPARTMENT OF EDUCATION
R E G I O N III
SCHOOLS DIVISION OFFICE OF BATAAN
Website: www.depedbataan.com | email: bataan@deped.gov.ph | FB Page: https://www.facebook.com/DepedBataan
Telephone / Fax : 047-2372102 | Address: Bataan Provincial Capitol Compound, Balanga City 2100