Republic of the Philippines Document Code: SDOZAMBS-PM-QF-OSDS-

Department of Education ADMIN-PERS-018

Region III
SCHOOLS DIVISION OF ZAMBALES
Zone VI, Iba, Zambales
Tel./Fax No. (047) 602 1391 Revision: 01
E-mail Address: zambales@deped.gov.ph
website: www.depedzambales.ph Effectivity date: 08-01-2019

APPLICATION FOR PERMISSION TO Name of Office:

STUDY OSDS – Personnel Section

_____________

(Schools Division Superintendent)

DepEd – Zambales
Iba, Zambales

Thru Channels:

SIR:

In accordance with B. P. S. Circular No. 17, s. 1960, I have the honor to request to study at
__________________________________________________________________________________.

Enclosed herewith is the list of subjects I have to take for the degree of ______________________________, duly
certified by the Dean / Registrar of ___________________________________________. After the school term, I will submit to
your office the true copy of the report card of the ratings I obtained together with the number of units earned, duly certified by the
Dean / Registrar of __________________________________________________________. My last afternoon session in the
Department of Education is 5:00PM.

________________________________
(Name)
_____________/ MAED / Ed. D Student

1st Indorsement
________________________ DISTRICT
___________________________, Zambales
_______________________

Respectfully forwarded to the Schools Division Superintendent, Iba, Zambales, Recommending approval herewith Application
for Permission to Study of ______________________________________, _________________________ under Regular
Permanent Status.

________________________________
Public Schools District Supervisor/
Secondary School Heads

APPROVED:
PERMISSION GRANTED UNTIL
DEGREE IS COMPLETED

______________________________
Schools Division Superintendent

______________
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 Republic of the Philippines Document Code: SDOZAMBS-PM-QF-OSDS-
Department of Education ADMIN-PERS-018
Region III
SCHOOLS DIVISION OF ZAMBALES
Zone VI, Iba, Zambales
Tel./Fax No. (047) 602 1391 Revision: 01
E-mail Address: zambales@deped.gov.ph
website: www.depedzambales.ph Effectivity date: 08-01-2019

APPLICATION FOR PERMISSION TO Name of Office:

STUDY OSDS – Personnel Section

Name of Applicant
Position
Work Station School
Address
School where School
Applicant intends Address
to Study
Course to be _________ Semester SY _____________
Pursued
List of Subjects Completed (if any)

Schedule of Classes
Subject/s to be taken for SY ______________ Time Day No. of Units

Latest Performance Rating: __________________ CERTIFIED CORRECT:

(Signature over Printed Name of Applicant)

RECOMMENDING APPROVAL: APPROVED:

____________________________
(Signature over Printed Name of Principal) Schools Division Superintendent

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