ANNEX

ANNEX A:
QAD Frontline Services Documentary
Requirements
 PROCESSING SHEET FOR APPLICATION OF PRIVATE SCHOOLS
FOR APPROVAL OF SCHEDULE OF FEES
Private Kindergarten/Elementary/Junior High School/Senior High School
Pursuant to DepEd Order No. 88, s. 2010; DO No. 11, s. 2011; Regional Memorandum No. 134, s. 2018

Registered Name of School: ___________________________________ SEC DTI

Complete Address of School: __________________________Email Add:_________________
Name of School Administrator __________________________Contact Nos.______________
Course Application: _____ Kindergarten
_____ Elementary (Grades 1 to 6)
_____ Junior High School (Grades 7 to 10)
_____ Senior High School (Grades 11 & 12)
School Year:__________________________Date Submitted to ROV:___________________

DOCUMENTARY REQUIREMENTS

No. Not
Name of Required Documents Available Available Remarks
(√) (x)
1 Indorsement Letter from SDO indicating among
others, the School’s Securities and Exchange
Commission (SEC) registered name and address.
2 Letter of Intent addressed to the Regional Director
signed by the School Head/Administrator, indicating
among others the school’s intention for such
schedule of fees/Tuition and Other School Fees
(TOSF).
3 Notarized Certificate of Authenticity and Veracity of
documents.
4 Statement under oath by the School
Head/Administrator of the itemized proposed rates
of tuition and other charges.
5 Proof of the consultation conducted with the duly
organized student government and the parents of
the pupils/students (Original Copy of the Minutes of
the Meeting with the Names and signature of the
attendees) on the proposed schedule of fees/TOSF.
6 Tabular presentation of Schedule of Tuition and
Other School Fees (TOSF) in Pesos (Php) per grade
or year level. (Other School Fees must be itemized
& should be attached to the computed schedule of
TOSF). This shall be reviewed by the SEPS or EPS
II of SM&ME. The reviewed Schedule of TOSF shall
be forwarded to the RO-QAD.
7 Certification under oath that 70% of the tuition and
other school fees (TOSF) or charges shall be
allocated for payment of salaries, wages, allowances
and other benefits of the members of the faculty and
all other employees of the school concerned and the
balance for institutional development, student
assistance and extension services and return of
investment.
8 Photocopy of the Government Permit/Government
Recognition.
9 Payroll on Teachers Salary Subsidy (TSS) of
Education Service Contracting (ESC) Scheme

1
 Participating School with a photocopy of PRC
License (for GASTPE recipient-schools).
10 List and Profile of Staff/Faculty Members by subject
area/course/level
11 Latest Certificate of Corporate Filing and Information
from Securities and Exchange Commission (SEC) or
Department of Trade and Industry (DTI).

Findings/Recommendations:
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________

Evaluated by: Date of Evaluation:

________________________________ _______________________
QAD EPS (Name and Signature)

Noted by:

____________________
Chief ES, QAD

2
PROCESSING SHEET FOR APPLICATION OF PRIVATE SCHOOLS FOR
APPROVAL OF WITH INCREASE IN TUITION
AND OTHER SCHOOL FEES (TOSF)
Private Kindergarten/Elementary/Junior High School/Senior High School
Pursuant to DO No. 88, s. 2010; DO No. 11, s. 2011; Regional Memorandum No. 134, s. 2018

Registered Name of School: ___________________________________ SEC DTI

Complete Address of School: __________________________Email Add:_________________
Name of School Administrator: _________________________Contact Nos._______________
Course Application: _____ Pre-Elementary (Kindergarten)
_____ Elementary (Grades 1 to 6)
_____ Junior High School (Grades 7 to 10)
_____ Senior High School (Grades 11 & 12)
SHS CATEGORY:
_____A-SUC
_____B-TESDA
_____C-LUC
_____D-CHED

School Year :__________________________Date Submitted to ROV:___________________

DOCUMENTARY REQUIREMENTS

No. Not
Name of Required Documents Available Available Remarks
(√) (x)
1 Indorsement Letter from SDO indicating among
others, the School’s Securities and Exchange
Commission (SEC/DTI/CHED/TESDA) registered
name and address.(Mayor’s Permit for LUC/SUC
2 Letter of Intent addressed to the Regional Director
signed by the School Head/Administrator, indicating
among others the school’s intention for such
increase or schedule of fees or signifying no
intention to increase the Tuition and Other School
Fees (TOSF).
3 Notarized Certificate of Authenticity and Veracity of
Documents
4 Statement under oath by the School
Head/Administrator of the itemized current rates of
tuition and other charges and the corresponding
itemized proposed charges thereon as well as the
new fees or charges proposed to be imposed and of
the proposed allocation of the incremental proceeds.
5 Latest Audited Financial Statements of the school.
6 Copy of the latest Income Tax Returns filed with the
Bureau of Internal Revenue (BIR).
7 Proof of the consultation conducted with the duly
organized student government and the parents of
the pupils/students (Minutes of the Meeting with the
Names and signature of the attendees) stating the
reason/s of increase.

1
 8 Comparative Schedule of Tuition and Other School
Fees (TOSF) for current School Year (SY) with that
of the previous SY indicating in both in Peso (Php)
and Percentage (%) the forms of increase. This
should be done both by the school With increase and
With No increase. (Other School Fees must be
itemized & should be attached to the comparative
schedule of TOSF). This shall be reviewed by the
SEPS or EPS II of SM&ME. The reviewed Schedule
of TOSF shall be forwarded to the RO-QAD.
9 Certification under oath that 70% of the tuition and
other school fees (TOSF) or charges shall be
allocated for payment of salaries, wages, allowances
and other benefits of the members of the faculty and
all other employees of the school concerned and the
balance for institutional development, student
assistance and extension services and return of
investment.
10 Photocopy of the approved Tuition and Other School
Fees (TOSF) of previous school year or latest
noted/approved fees.
11 Photocopy of the Government Permit/Government
Recognition
12 Payroll on Teachers Salary Subsidy (TSS) of
Education Service Contracting (ESC) Scheme
Participating School with a photocopy of PRC
License (for GASTPE recipient-schools).
13 List and Profile of Staff/Faculty Members by subject
area/course/level
14 Pictures/Photos of School Facilities needing
improvement
15 Latest Certificate of Corporate Filing and Information
from Securities and Exchange Commission (SEC) or
Department of Trade and Industry (DTI).
16 Annual Accomplishment Report of the previous year
to determine the performance of the school

Findings/Recommendations:
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________

Evaluated by: Date of Evaluation:

________________________________ _______________________
QAD EPS (Name and Signature)

Noted by:

_______________________
Chief ES, QAD

2
PROCESSING SHEET FOR APPLICATION OF PRIVATE SCHOOLS FOR
APPROVAL OF NO INCREASE IN TUITION
AND OTHER SCHOOL FEES (TOSF)
Private Pre-Elementary (Kindergarten)/Elementary/Junior High School/Senior High School
Pursuant to DO 88, s. 2010; DO 11, s. 2011; Regional Memorandum No. 134, s. 2018

Registered Name of School: __________________________________SEC DTI

Complete Address of School: __________________________Email Add :_________________
Name of School Administrator __________________________Contact Nos.______________
Course Application: _____ Pre-Elementary (Kindergarten)
_____ Elementary (Grades 1 to 6)
_____ Junior High School (Grades 7 to 10)
_____ Senior High School (Grades 11 & 12)
SHS CATEGORY:
_____A-SUC
_____B-TESDA
_____C-LUC
_____D-CHED

School Year:__________________________ Date Submitted to ROV:___________________

DOCUMENTARY REQUIREMENTS

No. Not
Name of Required Documents Available Available Remarks
(√) (x)
1 Indorsement Letter from SDO indicating among
others, the School’s Securities and Exchange
Commission (SEC/DTI/CHED/TESDA) registered
name and address.(Mayor’s Permit for LUC/SUC)
2 Letter of Intent addressed to the Regional Director
signed by the School Head/Administrator, indicating
among others the school’s intention not to increase
the Tuition and Other School Fees (TOSF).
3 Comparative Schedule of Tuition and Other School
Fees (TOSF) for current School Year (SY) with that
of the previous School Year indicating in both in
Peso (Php) and Percentage (%) the forms of
increase. This should be done both by the school
With increase and No increase. (Other School Fees
must be itemized & should be attached to the
comparative schedule of TOSF). This shall be
reviewed by the SEPS or EPS II of SM&ME. The
reviewed Schedule of TOSF shall be forwarded to
the RO-QAD.
4 Photocopy of the Government Permit/Government
Recognition.
5 Latest Certificate of Corporate Filing and Information
from Securities and Exchange Commission (SEC) or
Department of Trade and Industry
(DTI)/CHED/SUC/LUC/TESDA.
6 Photocopy of the approved Tuition and Other School
Fees (TOSF) of previous school year or latest
noted/approved TOSF (with breakdown of fees
attached.

1
Notes:
a. Please indicate N/A, if not applicable
b. Kindly submit all the lacking documents on or before_______________
c. Documents to be submitted must be two (2) sets, placed in separate folders, arranged
following the sequence above and labelled appropriately.
d. To facilitate evaluation, please do not include other documents not listed above.

Findings/Recommendations:
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________

Evaluated by: Date of Evaluation:

________________________________ _______________________
QAD EPS (Name and Signature)

Noted by:

____________________
Chief ES, QAD

2
 PROCESSING SHEET FOR APPLICATION OF PRIVATE SCHOOLS
FOR GOVERNMENT RECOGNITION
Private Kindergarten, Elementary, Junior High School
Pursuant to DO 88, s. 2010, DO 11, s. 2011, RM 59, s. 2016

Registered Name of School: ___________________________________ SEC DTI

Complete Address of School: __________________________ Email Add:_______________
Name of School Administrator __________________________Contact Nos.______________
Course Application: _____ Pre-Elementary (Kindergarten)
_____ Elementary (Grades 1 to 6)
_____ Junior High School (Grades 7 to 10)
School Year :__________________________Date Submitted to ROV:___________________

DOCUMENTARY REQUIREMENTS

No. Not
Name of Required Documents Available Available Remarks
(√) (x)
1 Indorsement Letter from SDO indicating among
others, the School’s Securities and Exchange
Commission (SEC) registered name and address.
2 Letter of Intent addressed to the Regional Director
signed by the School Head/Administrator tru the
SDS, indicating among others the school’s intention
to apply for Government Recognition (indicating the
course applied (course/grade/level)
3 Notarized Certificate of Authenticity and Veracity of
documents signed by the School Head/Administrator
4 Ocular/Site Inspection and Document Evaluation
Report prepared by the Division Supervisor and/or
SEPS-M&E In-Charge of Private School signed by
the Chief of the School Governance and Operation
Division (SGOD) using the Processing Sheet.
(Accomplished Processing Sheet must be included
in the Documents submitted to be reviewed by the
QAD EPS In-Charge).
5 Copy of the latest permit
6 Copy of Accomplishment Report/Achievements for
the past three (3) school years
7 Copy of the SEC Registration Certificate/DTI
Certificate
8 Copy of Transfer Certificate of Title (TCT) in the
name of the school or incorporator duly signed by
the Municipal/City Assessor Officer or Notarized
Copy of Deed of Donation/Usufruct/Perpetual Use
(maximum of 50 years) – Institutional/Educational
9 Copy of Transfer Certificate of Occupancy
(Institutional/Educational) -for newly built building/s
Note: Clearance from the City/Municipal Engineer
for the safety of the occupants
10 Official Receipt (O.R) for application and inspection
fee (Pre-Elem, Elem. And Junior High School)
11 Inspection Fee and Application Fees Receipt
(P2,020.00 + P2,020.00)
12 All facility requirements were compiled/maintained
(Pls. see separate Processing Sheet on the On-Site
Ocular Inspection Report)
1
 Course/Grade Level Official Receipt No. Date of Issuance
a. Kindergarten
b. Elementary
c. Junior High School

Findings/Recommendations:
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________

Evaluated by: Date of Evaluation: Conforme:

____________________________ _______________ ________________________

(Name and Signature of Evaluator) School Head/Administrator

Noted:

_____________________________
Chief ES

2
PROCESSING SHEET FOR APPLICATIONS FOR ISSUANCE OF SPECIAL ORDER (SO)
Pursuant to DepEd Order No.10 s. 2018 and Regional Memorandum No. 46, s. 2018

Registered Name of School: ________________________________________________

Complete Address of School:_______________________________________________
Name of School Administrator:___________________________Contact No.__________
Senior HS Track/Strand and Specialization: Track:_______________________________
_________________________________________________________________________
Strand:____________________Specialization:_____________________________
School Year:_________Total No. of Students:______Date Submitted to ROV:_________

DOCUMENTARY REQUIREMENTS

No. Name of Required Documents Not

Available Available Remarks
(√) (x)
1 Indorsement Letter from the Schools Division
Superintendent
2 Letter of intent addressed to the RD through channel
3 Attestation of Documents per school signed by the
SGOD Chief and Schools Division Superintendent
4 Masterlist of Grade 12 learners qualified to
graduate per section: track, strand, specialization
(spreadsheet submitted by the school)
5 SF 10 (Permanent Record)
6 Birth Certificate (NSO/PSA)
7 Approved Provisional Permit relative to specific
school year of SO application
Generated SO Form from the SO creator software
in four (4) copies with correct pagination.
8.5 by 13 size paper using four (4) colors
(Ivory, Yellow, Green and Pink)

Findings/Recommendations:
_______________________________________________________________________________
_______________________________________________________________________________

Evaluated by: Date of Evaluation:

_________________________ _______________________
Evaluator (Signature above printed name)

Noted by:

__________________________
Chief ES, QAD
 PROCESSING SHEET FOR APPLICATION OF GOVERNMENT PERMIT
TO OPEN/ESTABLISH A PRIVATE SCHOOL
Kindergarten/Elementary/Junior High School
Pursuant to DepEd Order No. 88, s. 2010 & Regional Memorandum No. 59, s. 2016

Registered Name of School: ___________________________________ SEC DTI

Complete Address of School: __________________________ Email Add:_______________
Name of School Administrator __________________________Contact Nos.______________
Course Application: _____ Kindergarten
_____ Elementary (Grades 1 to 6)
_____ Junior High School (Grades 7 to 10)
School Year :__________________________Date Submitted to ROV:___________________

DOCUMENTARY REQUIREMENTS AND REQUIRED FACILITIES

No. Name of Required Documents Not

Complied Complied Remarks
(√) (x)
1 Indorsement letter from the SDO indicating among
others, the School’s Securities and Exchange
Commission (SEC)/Department of Trade and
Industry (DTI) registered name and address.
2 Letter of Intent/Transmittal (including specific
school year of opening) addressed to the Regional
Director through the Schools Division
Superintendent
3 Board Resolution to open a new
school/course/grade/year level certified by the
Board Secretary for SEC registered schools
4 Notarized Certificate of Authenticity and Veracity
signed by the School Head/Administrator
5 Notarized Feasibility Study covering the following
factors/items:
Purpose and objectives of proposed school
or course;
Availability and adequacy of school site
and building, including documents of
ownership thereof, location plan,
development plan, pictures, or architect’s
plan of building, if the same is still to be
constructed;
Itemized cost of the project covering the
entire course in terms of site, site
development, school building and quarters,
classroom equipment and facilities, library,
salaries of faculty, and staff and
maintenance;
Financial capacity of applicant, including
his resources to provide the requirements
for the entire course and to support its
operation from year without depending
solely on students’ fees (Attach a Copy of
BIR Income and Financial Statement of the
owner/incorporators
Proposed faculty line-up and administrative
and supervisory staff together with their
individual Transcript of Records and

1
 evidence of willingness to join the school;
and
Need or demand for establishment of the
school or operation of the course in the
locality. If the course is already being
offered in the same town or city, there must
be an evidence of the following factors:
Distance of the applicant school to the
existing school
Enrolment in the existing school
Number of students in the same locality
enrolled in schools other than in the
existing school;
Number of prospective students of
applicant-school; and
Facilities, standards, and supportive
provisions for effective instruction and
quality education
6 Articles of Incorporation and by-Laws
7 Certificate of Registration with the DTI (for sole
ownership/single proprietorship
8 Securities and Exchange Commission (SEC)
Registration Certificate of the Lease Contract, if
not owned
9 SEC Certification
10 Copy of Transfer Certificate of Title of the school
site / usufruct / proof of ownership of the school
site / perpetual use
11 Document/Certification of the actual lot area/floor
area of building/s and classrooms duly signed by
the municipal or city engineer
12 Clearance/Permit from the Municipal/City DRRMO
stating that the proposed school site is not a high
risk area
13 Campus Development and landscaping plan duly
signed by proper authority
15 Certificate of Occupancy of school buildings duly
signed by proper authority
16 Latest Fire Inspection Certificate
17 Proposed Budget for the succeeding school year
approved by the school administrator/Board of
Trustees/Directors
19 Proposed Curriculum in accordance with DepEd
standards and requirements validated by the
Curriculum Implementation Division (CID)
20 Schedule of Tuition and Other School Fees
(TOSF) subject to approval of DepEd Regional
Director
21 List of School Administrators, their educational
Qualifications, school credentials (TOR’s),
certificate of trainings on school administration,
and expected salaries
22 List of Teaching/Academic Staff their educational
qualifications, school credentials (TOR’s), subject
assignments/salaries, other benefits, valid
contracts/appointments, proof of eligibility, PRC
license

2
23 List of Non-Teaching/Non-Academic Staff, their
educational qualifications, school credentials
24 Copy of Retirement Plan (SSS, Philhealth, Pag-
IBIG)
25 List and pictures with label of essential ancillary
services
Library and Library Holdings
guidance office
faculty room
medical and dental facilities
canteen
sports facilities and equipment
gender-sensitive comfort rooms and
lavatories
ramp for PWDs
others
26 List and Pictures of
school buildings
classrooms
standard flag pole
laboratories
water source and facilities
electrical facilities
school signage
27 School Anti-Bullying Policy
Child Protection Policy
Proposed Child Protection Committee
28 Student Handbook (Draft for approval and
enhancement of stakeholders)
29 Tentative Calendar of Activities for the School
Year
30 Class Program per Grade/Year level (workload,
no. of hrs, no. of learners in classroom/s)
31 Copy of Latest Updated/Insurance Certificate
32 Projected tentative enrollment
33 Ocular Inspection Report
Evaluation: Summary of findings, strong
points, and deficiencies noted
Recommendations strictly based on
findings during the visit and existing
standards and regulations
34 Inspection Fee (P 2,020.00) and Application Fees
Receipts per level (P 2,020.00). Please encircle
below the course applied for:
a.) Pre-Elem OR No. ____ Date of Issuance _____
b.) Elementary OR No. ____ Date of Issuance _____
c.) Junior HS OR No. ____ Date of Issuance _____

3
 Findings/Recommendations:
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________

Validated by: Date of Validation: Conforme:

____________________________ _______________ ________________________

(Name and Signature of Validator) School Head/Administrator

Noted:

___________________________
Chief ES

4
 PROCESSING SHEET FOR APPLICATION FOR RENEWAL
OF GOVERNMENT PERMIT
Private Kindergarten/Elementary/Junior High School/Senior High School
Pursuant to DepEd order No. 88, s. 2010 & Regional Memorandum No. 59, s. 2016

Registered Name of School: ___________________________________ SEC DTI

Complete Address of School: __________________________Email Add: _______________
Name of School Administrator __________________________Contact Nos._____________
Course Application: _____ Kindergarten
_____ Elementary (Specify Grade Levels _______________)
_____ Junior High School (Specify Grade Levels _____________)
_____ Senior High School (Specify Grade Levels _____________)

School Year: __________________________ Date Submitted to ROV: ___________________

DOCUMENTARY REQUIREMENTS

Not
No. Name of Required Documents Available Available Remarks
(√) (x)
1 Indorsement letter from Schools Division
Superintendent
2 Letter of Intent (Application Letter stating the nature
of Government Permit being applied for)
3 Certification of Authenticity and Veracity of
Documents from Schools Division Superintendent
4 Ocular Inspection/Progress Monitoring Report by
the In-Charge of Private Schools signed by the
Chief of Schools Governance and Operations
Division (SGOD)
5 Documentary Evaluation Report
>Refer to PS-QAD-07-Processing Sheet for Ocular
Inspection/Validation of Schools)
>Qualitative Evaluation Processing Sheet (QEPS) for
SHS only
6 Inspection Fee and Application Fees Receipt
(P2,020.00). Please encircle below the course
applied for.
1) KINDERGARTEN O.R. No.______Date of Issuance______
2) ELEMENTARY O.R. No.______Date of Issuance______
3) JUNIOR HS O.R. No.______Date of Issuance______
4) SENIOR HS O.R. No. _____ Date of Issuance _____

1
 Findings/Recommendations:
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________

Notes:
1. Please indicate N/A, if not applicable
2. Kindly submit all the lacking documents on or before_______________
3. Documents to be submitted must be two (2) sets, placed in separate folders, arranged
following the sequence above and labelled appropriately.
4. To facilitate evaluation, please do not include other documents not listed above.

Validated by: Date of Validation:

____________________________ _______________
(Name and Signature of Evaluator)

Noted:

________________________
Chief ES

2
 PROCESSING SHEET FOR APPLICATION FOR CONVERSION OF EXISTING
ELEMENTARY AND JUNIOR HIGH SCHOOL INTO A STAND-ALONE SENIOR
HIGH SCHOOL
Pursuant to DepEd Order No. 51, s. 2015.

Registered Name of School: ______________________________School ID: _________

Complete Address of School:_______________________________________________
Name of School Administrator___________________________Contact No.__________
Course Application:________________________________________________________
School Year:____________________________Date Submitted to ROV:______________

DOCUMENTARY REQUIREMENTS

No. Not
Name of Required Documents Available Available Remarks
(√) (x)
1 Indorsement letter
2 Certification of DepEd School Identification (ID)
prepared by the Planning Unit
3 Letter-request for Implementation of the SHS
program addressed to the Schools Division
superintendent (SDS)
4 Certification signed by the SDS stating that no public
SHS is offering the same SHS track within the
catchment area
___a. Justification signed by the SDS, in case will
offer the same SHS track
5 Implementation Plan, for SHS program covering five
(5) years to including among others:
___a. Current and projected enrollment for (5) years,
by grade level;
___b. Proposed budgetary requirements for
Personnel Services, Maintenance and other
Operating Expenses, and Capital
Outlay.
___c. Operational Plan regarding curriculum and
Instructional Supervision of the proposed
SHS.
___d. School Site Development Plan to include
proposed school buildings, as needed.
6 Certification signed by the School Head, duly
attested by the SDS on the excess classrooms,
tables, chairs and other resources to be used in the
implementation of SHS program.
7 Inventory of learning resources prepared by the
Property Custodian as validated by the Schools
Division Office
8 Updated Personnel Services Itemization and
Plantilla of Personnel of the concerned school.
9 Updated Status Report with regards to the existing
crucial resources.
10 .Map, preferably drawn to scale, showing the vacant
lot where the proposed SHS classrooms/school
building are/will be constructed, duly certified by the
Municipal/City Engineer.

1
11 List of prospective enrollees in SHS per track and
strand, indicating their names, Learner Reference
Number (LRN), where applicable, age, addresses,
school names, DepEd School ID Numbers where
they are currently or previously enrolled
___a. Justification signed by the SDS, in case the
required minimum enrolment and/or number
of tracks are not satisfied.
12 List and types of establishment and industries in the
community, as attested to by the Department of
Trade and Industry, Department of Labor and
Employment or the Municipal Planning Officer.
13 Certification from the SDS that the track (s) and
strand (s) to be offered are aligned with the Local
Development Plans, as evident in the list provided
by the Municipal/City Mayor , and are decided upon
by the Regional Director, SDS, Division Planning
Officer and School Head concerned.
14 Result of internal assessment or survey done with
the prospective enrollees.
15 List of tracks and strands to be offered, duly signed
by the RD or SDS, Planning Officer and School
Head.
16 MOA executed between the SDS and the partner
entity enumerating the respective roles of both
parties.
17 Immersion Deployment Plan.
18 Certification duly signed by the SDS on the
compliance to the following conditions:

___a. Learners are not denied access to elementary

and JHS education as the result of the
conversion

___b. Prior consultation with both internal and

external stakeholders is conducted for the
purpose by the SDS and School Head of the
concerned elementary or JHS

___c. Health and safety of any learner is not

compromised as a result of the conversion
and subsequent transfer of elementary and/
or JHS learners, taking into consideration the
distance to be travelled to and from the new
school site.

___d. Affected school personnel shall not be

displaced and demoted, and shall be
transferred to the nearest school were the
services are needed.
19 Sangguniang Bayan/Panglungsod Resolution
signifying the Local Government Unit support to the
conversion of the school into an SHS, duly approved
by the Municipal/City Mayor.

2
Notes:
a. Please indicate N/A, if not applicable
b. Kindly submit all the lacking documents on or before_______________
c. Documents to be submitted must be two (2) sets, placed in separate folders,
arranged following the sequence above and labelled appropriately.
d. To facilitate evaluation, please do not include other documents not listed above.

Findings/Recommendations:
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________

Evaluated by: Date of Evaluation:

________________________________ _______________________
QAD EPS (Name and Signature)

Noted by:

______________________
Chief ES, QAD

3
 PROCESSING SHEET FOR APPLICATION FOR CONVERSION OF SCHOOLS
Elementary/Secondary School (s) into an Integrated School
Pursuant to DepEd Order No. 40, s. 2014.
(Item A.4b pp 9-11; B.4.b pp 20; Annex 4-C.b pp 44-45; D-4b pp 166-171)

Registered Name of School: ________________________________________________

Complete Address of School:_______________________________________________
Name of School Administrator___________________________Contact No.__________
Course Application:________________________________________________________
School Year:____________________________Date Submitted to ROV:______________

DOCUMENTARY REQUIREMENTS

No. Not
Name of Required Documents Available Availabl Remarks
(√) e
(x)
1 Indorsement Letter
2 Evaluation Report of DREC
3 DepEd School ID(s)
4 Letter-request for the conversion of schools into
Integrated Schools (IS) addressed to the Schools Division
superintendent (SDS)
5 In case of expansion of existing school:
___a. Feasibility Study on the proposed expansion
of school, duly recommended/endorsed by the
SDS.
___b. IS Implementation Plan, covering five (5)
years to including among others, the following;
1. Current and projected enrolment for (5)
years,by grade level;

2. Proposed budgetary requirements for

Personnel Services, MOOE, and Capital
Outlay.

3. Operational Plan regarding curriculum and

Instructional Supervision of the proposed
IS; and

4. School Site Development Plan to include

proposed school buildings, as needed.
___c. Certification Signed by the School Head, duly
attested by the SDS on the excess
classrooms, tables, chairs and other
resources to be used for the expansion the
elementary or secondary school;
___d. Inventory of learning resources prepared by
the School’s Property Custodian, as validated
by the Schools Division Office (SDO);.
___e. Updated Personnel Services Itemization and
Plantilla of Personnel (PSIPOP) of the
Concerned school(s); and
___f. Updated Status Report with regard to the
Schools existing crucial resources.

1
6 In case of merging or combination of existing elementary
and secondary school(s):
__a. Feasibility on the proposed merging or
Combination of schools, duly recommended/
Endorsed by the SDS.
__b. IS Implementation Plan, covering five (5)
years to including among others, the following;
1. Current and projected enrolment for (5) years,by
grade level;
2. Proposed budgetary requirements for Personnel
Services, MOOE, and Capital Outlay.
3. Operational Plan regarding curriculum and
Instructional Supervision of the proposed IS; and
4. School Site Development Plan to include proposed
school buildings, as needed.
___c. Inventory of learning resources prepared by
the School’s Property Custodian, as validated
by the Schools Division Office (SDO);.
___d. Updated Personnel Services Itemization and
Plantilla of Personnel (PSIPOP) of both school
To be integrated.
___e. Map, preferably drawn to scale, showing the
distance of the existing schools within the
catchment area of the proposed new school,
duly certified by the Municipal/City Engineer
and validated by the Schools Division Office.
___f. Duly notarized MOA on merging or
combination of school, drawn up by and
between the School Heads of both schools
indicating among others, then integration of
crucial resources for the proposed IS.
7 Sangguniang Bayan/Panglungsod Resolution supporting
the conversion of school(s) into an IS, duly approved by
the Municipal/City Mayor, indicating therein the proposed
name of the school.
8 Certification from the LGU signed by the Municipal/City
Mayor, as the case may be, where the LGU shall continue
to provide funds for the operation and maintenance for at
least 5 years or until such time that such funds are
incorporated in the national
Budget.
9 Designation Order for the proposed School Head.
10 Transcript of Records, Certificate of Relevant Training,
Service record and Civil Service elegibility of the proposed
School Head, duly certified as true copy by the Division
Office’s Record Unit.
11 Justification by the SDS, in case the proposed School
Head does not meet the qualification standard for School
Head item for secondary school.
12 Certification from the SDS as to the school assignment of
the other School Head who will not be selected, in case
both schools to be merged or combined are with existing
School Heads.

2
Notes:
a. Please indicate N/A, if not applicable
b. Kindly submit all the lacking documents on or before_______________
c. Documents to be submitted must be two (2) sets, placed in separate folders,
arranged following the sequence above and labelled appropriately.
d. To facilitate evaluation, please do not include other documents not listed above.

Findings/Recommendations:
____________________________________________________________________________
____________________________________________________________________________

Validated by: Date of Validation:

__________________________ __________________________
QAD EPS (Name and Signature)

Noted by:
________________________
Chief ES, QAD

3
 PROCESSING SHEET FOR APPLICATION FOR CONVERSION OF SCHOOLS
High Schools classified as Non-Implementing Unit into a High School classified as
Implementing Unit
Pursuant to DepEd Order No. 40, s. 2014.
(Items A.4, C.3 pp. 2-3; 8.4.c.2 pp 24-26; D-4d pp 80-84; Annex 4c.d pp 45-46)

Registered Name of School: _______________________________School ID: _______

Complete Address of School:_______________________________________________
Name of School Administrator___________________________Contact No.__________
Course Application:________________________________________________________
School Year:____________________________Date Submitted to ROV:______________

DOCUMENTARY REQUIREMENTS

No. Not
Name of Required Documents Available Available Remarks
(√) (x)
1 DREC Evaluation Report
2 School’s latest and updated Personnel Itemization
and Plantilla of Personnel (PSIPOP).
3 Approval of school’s Agency Code by DBM.
4 Designation documents duly signed by the School
Head.
5 Certificates of Training attended by the
designated/appointed financial staff related to
financial management.
6 Certification of the School Head as to the capability
of the school to comply with the submission of
financial reports to the oversight agencies such as
COA, DBM, NEDA, House of Representatives, etc.
7 Copy of the General Appropriation Act (GAA) were
the appropriation of the school is reflected.
8 Enhanced Basic Education Information System
(EBEIS) data on enrolment per grade level for the
current school year.
9 Letter-request from the School Head addressed to
the Schools Division Office (SDO).
10 Endorsement Letter from the SDO to the Regional
Office.
11 Endorsement Letter from the Regional Office to the
Central Office..

1
Notes:
a. Please indicate N/A, if not applicable
b. Kindly submit all the lacking documents on or before_______________
c. Documents to be submitted must be two (2) sets, placed in separate folders,
arranged following the sequence above and labelled appropriately.
d. To facilitate evaluation, please do not include other documents not listed above.

Findings/Recommendations:
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________

Evaluated by: Date of Evaluation:

________________________________ _______________________
QAD EPS (Name and Signature)

Noted by:

________________________
Chief ES, QAD

2
 PROCESSING SHEET FOR APPLICATION FOR CONVERSION OF SCHOOLS
High School to Science High School
Pursuant to DepEd Order No. 40, s. 2014.
(Items A.4; C.2 pp. 12-13; B.4; C.2 pp. 24-26, D.4 pp. 80-84; Annex 4c, 4d pp 45-46)

Registered Name of School: _________________________________School ID: ______

Complete Address of School:_______________________________________________
Name of School Administrator___________________________Contact No.__________
Course Application:________________________________________________________
School Year:____________________________Date Submitted to ROV:______________

DOCUMENTARY REQUIREMENTS

No. Not
Name of Required Documents Available Available Remarks
(√) (x)
1 Indorsement letter
2 Evaluation Report of DREC
3 Certification of National Achievement Test (NAT)
Result
4 Certification of the organizers of
International/National/Regional Mathematics and
Science Competitions.
5 Current school Program, signed by the School Head
and approved by the Schools Division
Superintendent (SDS).
6 Copy of curriculum guide and special science
curriculum.
7 Certified true copies of Transcript of Records of
School Head.
8 Certified true copy of Certificate of Training in
Science/ Mathematics subject attended by the
School head.
9 Certified true copy of the Transcript of Records of
Science and Mathematics Teachers
10 Copy of the LET-PRC Ratings of teachers indicating
their field of specialization, concentration (e.g.
mathematics, physical science, biological science,
chemistry, general science, etc.).

Evaluated by: Date of Evaluation:

________________________________ _______________________
QAD EPS (Name and Signature)

Noted by:

________________________________
Chief ES, QAD

1
 PROCESSING SHEET FOR APPLICATION FOR CONVERSION OF SCHOOLS
High School to a Technical-Vocational school
Pursuant to DepEd Order No. 40, s. 2014.

Registered Name of School: _______________________________School ID: _______

Complete Address of School:_______________________________________________
Name of School Head: _________________________________Contact No.__________
Course Application:________________________________________________________
School Year of Intended Operation:_________Date Submitted to ROV:______________

DOCUMENTARY REQUIREMENTS

No. Not
Name of Required Documents Available Available Remarks
(√) (x)
1 Indorsement Letter from the SDS
2 Evaluation Report of DREC
3 Letter of Intent of SH addressed to the RD through
the SDS
4 Current School Program signed by the School Head
and approved by the SDS.
5 Copy of the Technical-Vocational guide
(Competency-Based Curriculum) and special
technical-vocational curriculum.
6 Approved from the Office of the Undersecretary for
Program and Projects on the technical-vocational
course to be offered by the school, aligned with
TESDA Training Regulations.
7 Certification from the School Head that the technical-
vocation course being offered:
___a. is relevant to the needs of the community/local
Industry.
___b. has available localized curriculum In
Partnership with the local industry/ies; and
___c. is based on specialization aligned with TESDA
Training Regulations, for assessment and
employment purposes.
8 Notarized Feasibility Study, duly recommended by
the SDS, indicating the following:
___a. Need to convert to Technical-Vocational
School;
___b. Current and projected enrolment for a period
of five (5) years;
___c. Demand to open a Technical-Vocational
course;
___d. Organizational Structure;
___e. School Development Plan; and
___f. Proposed Budget/Budgetary Requirements.
9 Certified true copies of Transcript of Records of
School Head.
10 Certified true copy of National Certificate (NC) or
higher certificate for technical-vocational course
attended by the School Head as issued by TESDA.
11 Certified true copy of the Transcript of Records of
Technical-Vocational Teachers

1
 12 Certified true copies of NC II or higher certificate
issued by TESDA of Technical-Vocational Teachers
on special technical-vocational skills.
13 Copy of the LET-PRC Ratings of teachers indicating
their field of specialization/concentration.
14 Updated Teacher’s Profile.
Inventory of learning resources per specialization
15 prepared by the School’s Property Custodian and
validated by the Schools Division Office.
16 Certification on the School Head that the relevant
resources of the school are adequate, duly validated
by the SDO
17 Sangguniang Bayan/Panglungsod Resolution
supporting the conversion of the school, duly
approved by the Municipal/City Mayor, indicating
therein the proposed name of the school
18 Certification from the LGU signed by the
Municipal/City Mayor, as the case may be, where the
LGU shall continue to provide funds for the operation
and maintenance for at least 5 years or until such
time that such funds are incorporated in the national
Budget.
19 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.
20 Justification from the SDS in case the required size
of technical-vocational school site cannot be met.

Notes:
a. Please indicate N/A, if not applicable
b. Kindly submit all the lacking documents on or before_______________
c. Documents to be submitted must be two (2) sets, placed in separate folders,
arranged following the sequence above and labelled appropriately.
d. To facilitate evaluation, please do not include other documents not listed above.

Findings/Recommendations:
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________

Validated by: Date of Validation:

________________________________ _______________________
QAD EPS (Name and Signature)

Noted by:

_______________________
Chief ES, QAD

2
 PROCESSING SHEET FOR APPLICATION FOR ESTABLISHMENT OF A
STAND- ALONE SENIOR HIGH SCHOOL (SHS)
Pursuant to DepEd Order No. 51, s. 2015.

Registered Name of School: ________________________________________________

Complete Address of School:_______________________________________________
Name of School Administrator___________________________Contact No.__________
Course Application:________________________________________________________
School Year:____________________________Date Submitted to ROV:______________

DOCUMENTARY REQUIREMENTS

No. Not
Name of Required Documents Available Available Remarks
(√) (x)
1 Indorsement letter
2 Letter-request from interested parties addressed to
the Schools Division superintendent (SDS) e.g. from
PTA or Barangay Council, etc., or recommendation
from the SDS to open a stand-alone SHS
___a. Justification on the need to establish a stand-
alone SHS.
3 Track(s),Strand(s) to be offered as well as their
respective number of prospective enrollees.
4 School Environment (environmental scanning/
situation analysis)
16 List and types of establishment and industries in the
community, as attested to by the Department of
Trade and Industry, Department of Labor and
Employment (DOLE) or the Municipal Planning
Officer
17 Certification from the SDS that the track (s) and
strand (s) to be offered are aligned with the Local
Development Plans, as evident in the list provided
by the Municipal/City Mayor , and are decided upon
by the RD od SDS, Division Planning Officer.
Result of internal assessments or surveys done with
18 the prospective enrollees.
19 List of tracks and strands to be offered, duly signed
by the RD or SDS, Planning Officer and School
Head.
20 Accomplished SHS Site Appraisal Form (refer to
Annex E).
21 SHS building plan indicating the number and
technical specification of the classrooms to be built.
22 SHS building permit issued by the City/Municipal
Engineer.
23 Bureau of Fire Protection Certificate
24 In case classrooms are already constructed,
Inspection Report fro the Division In-Charge of
Facilities Section.
25 MOA executed between the SDS and the partner
entity enumerating the respective roles of both
parties.
26 Immersion Deployment Plan.

1
Notes:
a. Please indicate N/A, if not applicable
b. Kindly submit all the lacking documents on or before_______________
c. Documents to be submitted must be two (2) sets, placed in separate folders,
arranged following the sequence above and labelled appropriately.
d. To facilitate evaluation, please do not include other documents not listed above.

Findings/Recommendations:
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________

Evaluated by: Date of Evaluation:

________________________________ _______________________
QAD EPS (Name and Signature)
Noted by:

_____________________
Chief ES, QAD

2
 PROCESSING SHEET FOR APPLICATION FOR ESTABLISHMENT OF PUBLIC
ELEMENTARY/SECONDARY SCHOOL
Pursuant to DepEd Order No. 40, s. 2014

Registered Name of School: ________________________________________________

Complete Address of School:_______________________________________________
Name of School Administrator___________________________Contact No.__________
Course Application:________________________________________________________
School Year:____________________________Date Submitted to ROV:______________

DOCUMENTARY REQUIREMENTS

No. Not
Name of Required Documents Available Available Remarks
(√) (x)
1 Indorsement letter
2 Letter request to open a school addressed to the
Schools Division Superintendent (SDS) (Either from
PTA or Barangay Council).
3 Feasibility study, duly recommended/endorsed by
the SDS including the following:
a. Justification on the need to establish a school;
b. Proposed Organizational Structure;
c. School Environment (Environmental
scanning/situational analysis);
d. Proposed School Development Plan; and
e. Proposed Budget/Budgetary Requirements
(to cover the proposed school’s crucial
resources)
4 Division Inspection Report signed by the SDS.
5 Sangguniang Bayan/Panglungsod Resolution
supporting the establishment of a school duly
approved by the Municipal Mayor/City Mayor,
indicating therein the proposed name of the school.
6 List of prospective enrollees per grade level,
including their names, age and addresses and or
school/or school where they are currently or were
enrolled.
7 Justification on the need for the establishment of an
MG school, if necessary.
8 Certification from the SDS that no private high school
within the Municipality/City is participating in the
GASTPE Program of DepEd, or that GASTPE
participating high school has reach its allocation or
number of available slots; OR
9 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.
10 Map, preferably drawn to scale, showing the
distance of the existing schools within the catchment
area of the proposed new school, duly certified by
the Municipal/City Engineer.
11 Certification from the Municipal/City Engineer that
the proposed school is not within the 2-km radius (for

1
 the rural areas) and I km radius (for the urban areas)
from the existing elementary/high school.
12 Justification from the SDS for the waiver on the 2 or
1 km radius requirement, if necessary.
13 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.
14 Justification from the SDS in case the required size
of school size cannot be met.
15 Clearance from the Provincial Mines and .
Geoscience Bureau (MGB) and the Regional Office
of the Department of Environment and Natural
Resources (DENR) stating that the proposed school
site is not a high risk area.
16 School site development plan.
17 School building plan indicating the number and
technical specification of the classroom to be built.
18 School building design duly approved by Deped
Education Facilities Division, Administrative Service.
19 School Building Permit issued by the Municipal/City
Engineer.
20 Bureau of Fire Protection Certificate.
21 Inspection Report from the Division In-Charge of
Facilities Section, in case classrooms are already
constructed.
22 Duly notarized MOA* by and between DepEd,
represented by SDS, and LGU, represented by the
Municipal/City Mayor or Provincial Governor, as the
case may be, where the LGU shall provide funds for,
among others, the following:
____a. Construction of the new building(s);
____b. Procurement of Educational Facilities,
furnitures, textbooks and instructional
materials;
____c. Operation and maintenance for at least five
(5) years or until such time when funds for
The purpose are incorporated in the national
budget; and
____d. Salaries of teaching and non-teaching
personnel, preferably at par with national
salary rates.
23 Sangguniang, Bayan/Panlalawigan/Panglungsod
Resolution for the purpose.
24 Certification from the Schools Superintendent that
the Division Office has sufficient fund to cover
resulting expenses, if any,
25 List of teaching and non-teaching personnel to be
borrowed from the existing nearby school(s), duly
identified by their respective Item Number Per
Personnel Itemization and Plantilla of Personnel
(PSIPOP) and name of school, if any.

2
Notes:
a. Please indicate N/A, if not applicable
b. Kindly submit all the lacking documents on or before_______________
c. Documents to be submitted must be two (2) sets, placed in separate folders,
arranged following the sequence above and labelled appropriately.
d. To facilitate evaluation, please do not include other documents not listed above.

Findings/Recommendations:
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________

Evaluated by: Date of Evaluation:

________________________________ _______________________
QAD EPS (Name and Signature)

Noted by:

_______________________
Chief ES, QAD

3
PROCESSING SHEET FOR APPLICATION FOR IMPLEMENTATION OF SENIOR
HIGH SCHOOL (SHS) PROGRAM IN EXISTING JUNIOR HIGH SCHOOL (JHS)
AND INTEGRATED SCHOOLS (IS)
Pursuant to DepEd Order No. 51, s. 2015.

Registered Name of School: ___________________School ID: ____________________

Complete Address of School:_______________________________________________
Name of School Head: _________________________________Contact No.__________
Course Application:________________________________________________________
School Year of Intended Operation:_________Date Submitted to ROV:______________

DOCUMENTARY REQUIREMENTS

No. Not
Name of Required Documents Available Available Remarks
(√) (x)
1 Indorsement Letter from the SDS
2 Evaluation Report of DREC
3 Certification of the DepEd School Identification (ID)
from the Planning Office
4 Letter-request for Implementation of the SHS
program addressed to the Schools Division
superintendent (SDS)
5 Certification signed by the SDS stating that no public
SHS is offering the same SHS
tracks/strands/specializations within the catchment
area
6 Implementation Plan, for SHS program covering five
(5) years to include among others:
___a. Current and projected enrollment for (5) years,
by grade level;
___b. Proposed budgetary requirements for
Personnel Services, MOOE, and Capital
Outlay.
___c. Operational Plan regarding curriculum and
Instructional Supervision of the proposed
SHS.
___d. School Site Development Plan to include
proposed school buildings, as needed.

5 Certification signed by the School Head, duly

attested by the SDS on the excess classrooms,
tables, chairs and other resources to be used in the
implementation of SHS program.
6 Updated inventory of learning resources prepared by
the Property Custodian as validated by the Schools
Division Office
7 Updated Personnel Services Itemization and
Plantilla of Personnel of the concerned school.
8 Updated Status Report with regards to the existing
crucial resources.
9 Map, preferably drawn to scale, showing the vacant
lot where the proposed SHS classrooms/school
building are/will be constructed, duly certified by the
Municipal/City Engineer.
1
 10 List of prospective enrollees in SHS per track, strand
and specialization indicating their names, Learner
Reference Numbers (LRNs), ages, addresses,
name of schools, and DepEd School ID Numbers
where they are currently or previously enrolled with
justification signed by the SDS, in case the required
minimum enrolment and/or number of
tracks/strands/specializations are not satisfied.
11 List and types of establishment and industries in the
community, as attested to by the Department of
Trade and Industry, Department of Labor and
Employment or the Municipal Planning Officer.
12 Certification from the SDS that the track/s, strand/s
and specialization/s to be offered are aligned with
the Local Development Plans, as evident in the list
provided by the Municipal/City Mayor , and are
decided upon by the Regional Director, SDS,
Division Planning Officer, and School Head
concerned.
13 Result of internal assessment or survey done with
the prospective enrollees.
14 List of tracks, strands, and specializations to be
offered, duly signed by the RD or SDS, Planning
Officer and School Head.
15 MOA executed between the SDS and the partner
entity enumerating the respective roles of both
parties.
16 Immersion Deployment Plan signed by the School
Head
17 Certification of Authenticity and Veracity duly
notarized

Notes:
a. Please indicate N/A, if not applicable
b. Kindly submit all the lacking documents on or before_______________
c. Documents to be submitted must be two (2) sets, placed in separate folders,
arranged following the sequence above and labelled appropriately.
d. To facilitate evaluation, please do not include other documents not listed above.

Findings/Recommendations:
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________

Validated by: Date of Validation:

________________________________ _______________________
QAD EPS (Name and Signature)

Noted by:

_________________________
Chief ES, QAD
2
 PROCESSING SHEET FOR APPLICATION FOR MERGING OF
ELEMENTARY/SECONDARY SCHOOLS
Pursuant to DepEd Order No. 40, s. 2014.

Registered Name of School: ________________________________________________

Complete Address of School:_______________________________________________
Name of School Administrator___________________________Contact No.__________
Course Application:________________________________________________________
School Year:____________________________Date Submitted to ROV:______________

DOCUMENTARY REQUIREMENTS

No. Not
Name of Required Documents Available Available Remarks
(√) (x)
1 Indorsement letter
2 DepEd School ID of the school to be merged.
3 Map, preferably drawn to scale, showing the
distance of the existing schools within the catchment
area of the proposed new school, duly certified by
the Municipal/City Engineer and validated by the
Schools Division Office.
4 Letter-request on the proposed merging of schools
addressed to the Schools Division superintendent
(SDS)
5 Feasibility Study on the proposed merging of
schools, duly endorsed by the SDS.
6 Proposed School’s Implementation Plan, as merged,
covering five (5) years to including among others, the
following;
___a. Current and projected enrollment for (5) years,
by grade level;
___b. Proposed budgetary requirements for
Personnel Services, MOOE, and Capital
Outlay.
___c. Strategic Plan regarding curriculum and
Instructional Supervision of the proposed
School;
___d. School Site Development Plan of the schools
to be merged, including proposed school
buildings, as needed.
7 Updated Status Report of the schools to be merged
with regard to their existing crucial resources.
8 Inventory of learning resources prepared by the
Property Custodian. of both schools to be merged.
9 Updated Personnel Services Itemization and
Plantilla of Personnel (PSIPOP) of both schools to
be merged.
10 Duly notarized MOA on merging of schools, drawn
up by and between the SDS and School Heads
concerned indicating among others, the crucial
resources to the proposed merged school.
11 Designation Order for the OIC/TIC of the merged
schools, duly signed by the SDS.
12 Sangguniang Bayan/Panglungsod Resolution
supporting the Merging of the schools, duly
1
 approved by the Municipal/City Mayor, indicating
therein the proposed name of the school.
13 Certification from the LGU signed by the
Municipal/City Mayor, as the case may be, where the
LGU shall continue to provide funds for the operation
and maintenance of the merged school.
14 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 of both schools.

Notes:
a. Please indicate N/A, if not applicable
b. Kindly submit all the lacking documents on or before_______________
c. Documents to be submitted must be two (2) sets, placed in separate folders,
arranged following the sequence above and labelled appropriately.
d. To facilitate evaluation, please do not include other documents not listed above.

Findings/Recommendations:
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________

Evaluated by: Date of Evaluation:

________________________________ _______________________
QAD EPS (Name and Signature)

Noted by:

_____________________
Chief ES, QAD

2
 PROCESSING SHEET FOR APPLICATION FOR SEPARATION OF SCHOOL
ANNEX
Pursuant to DepEd Order No. 40, s. 2014.

Registered Name of School: _________________________________School ID: _______

Complete Address of School:_______________________________________________
Name of School Administrator___________________________Contact No.__________
Course Application:________________________________________________________
School Year:____________________________Date Submitted to ROV:______________

DOCUMENTARY REQUIREMENTS

No. Not
Name of Required Documents Available Available Remarks
(√) (x)
1 Indorsement letter
2 Certification of DepEd School ID prepared by the
Planning Unit.
3 Approval on the establishment of school annex by
DepEd Central/Regional Office.
4 Sangguniang Bayan/Panglungsod Resolution
supporting the separation of the school annex, duly
approved by the Municipal/City Mayor, indicating
therein the proposed name of the school.
5 Request for separation of the school annex
concerned, duly recommended/endorsed by the
School Division Superintendent (SDS) and/ or
stakeholders;
5 Feasibility Study, indicating the following:
a. Justification on the need to separate a school
annex.
b. Proposed Organizational Structure;
c. School Environment (environmental
scanning/situational analysis);
d. Proposed school Development Plan; and
e. Proposed Budget/Budgetary requirement.
6 Inventory of crucial resources to be transferred to the
proposed school to be separated, duly signed by the
mother school’s Property Custodian.
7 Duly notarized MOA regarding the separation of
school annex, drawn up by and between the School
Head of the mother school and Officer In-Charge
(OIC) Teacdher In-Charge (TIC) of the school
annex, indicating among others, the transfer of
crucial resources to the proposed regular school, as
follows;
a. Teaching and non-teaching items pursuant to
the existing DepEd-DBM staffing standards
for schools;
b. Funds for personnel services based on the
actual salaries of the school personnel both
teaching and non-teaching) to be transferred;
c. Funds for Maintenance and Other Operating
Expenses (MOOE);
e .Other funding requirements until such time that
the school’s funding requirement in integrated
1
 in the General Appropriation Act (GAA).
8 Justification from the School Head of SDS in case
the required MOA (from item 7 above) cannot be
met.
9 Latest and updated Personnel Services Itemization
and Plantilla of Personnel (PSIPOP) including
proposal for item for Principal I and additional
teachers and support personnel.
10 List of enrollees by grade level, duly signed by the
School Head/Teacher-In-Charge and attested by the
SDS.
11 Justification from the SDS in case item 10 cannot be
met.
12 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.
13 Justification from the SDS in case item 12 cannot be
met.

Notes:
a. Please indicate N/A, if not applicable
b. Kindly submit all the lacking documents on or before_______________
c. Documents to be submitted must be two (2) sets, placed in separate folders,
arranged following the sequence above and labelled appropriately.
d. To facilitate evaluation, please do not include other documents not listed above.

Findings/Recommendations:
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________

Evaluated by: Date of Evaluation:

________________________________ _______________________
QAD EPS (Name and Signature)

Noted by:

______________________
Chief ES, QAD

2
 ANNEX B:
DepEd Memorandum No. 4, s. 2014 –
Guidelines on the Preparation for the
National Implementation of the Senior
High School (SHS) Program in Non-
DepEd Schools for the School Year (SY)
2016-2017 and Onwards
 ANNEX C:
DepEd Central Office Client Feedback
Form
 Republic of the Philippines Republic of the Philippines
Department of Education Department of Education
Client Feedback Form Control No.: ___ Client Feedback Form Control No.: ___

Your experience matters to us! Ang iyong karanasan ay mahalaga sa amin!

I. Client Information I. Impormasyon ng Kliyente

Name (Optional): ______________________________________________ Date Visited: ____/____/_________ Pangalan (Opsyonal): _____________________________________ Petsa ng Pagbisita: ____/____/_________
Office Visited: ________________________________________________ Phone No. (Optional): ____________ Opisinang Bibisitahin: ___________________________________________ Phone No. (Opsyonal): ___________
Purpose of Visit (Please specify): ________________________________________________________________ Layunin ng Pagbisita: _________________________________________________________________________
Time Started: _________ Time Finished: _________ Oras Nagsimula: _________ Oras Natapos: _________

II. Client Satisfaction Rating II. Client Satisfaction Rating

Kindly rate the quality of service provided by checking the appropriate box. Lagyan ng tsek ang kahon na tumutugma sa inyong sagot.

Very Dissatisfied Dissatisfied Neutral Satisfied Very Satisfied Very Dissatisfied Dissatisfied Neutral Satisfied Very Satisfied

1. PHYSICAL 1. PISIKAL
The environment is clean and orderly Ang kapaligiran ay malinis at maayos

2. SERVICES 2. SERBISYO
Your concern was addressed promptly and Ang pangangailangan ay natugunan ng maayos at
appropriately karapat dapat
3. PERSONNEL 3. KAWANI
The employee was courteous and accommodating Ang kawani ay magalang at maasikaso

*OVERALL RATING FOR THE SERVICE PROVIDED: *OVERALL RATING FOR THE SERVICE PROVIDED:
How satisfied are you with the quality of services Gaano ka kakuntento sa kalidad ng mga serbisyong
provided? naibigay?

III. Suggestions/Compliments/Comments III. Suhestiyon/Papuri/Komento

__________________________________________________________________________________________ __________________________________________________________________________________________
__________________________________________________________________________________________ __________________________________________________________________________________________
__________________________________________________________________________________________ __________________________________________________________________________________________
Thank you for your valuable input to help us continuously improve our services! Maraming salamat sa inyong tulong sa para sa ikauunlad ng aming serbisyo!

Privacy Notice: Privacy Notice:

The personal information included in this document should only be used for the purposes of Ang mga personal na impormasyon sa dokumentong ito ay maaari lamang gamitin pra sa layunin ng
administering the survey. Any personal information included herein may not be used for other purposes survey. Hindi ito gagamitin sa iba pang mga layunin maliban sa nabanggit.
aside from those stated above.