Republic of the Philippines
Department of Education
APPLICATION FOR IMPLEMENTATION OF SENIOR HIGH SCHOOL (SHS) PROGRAM IN EXISTING JUNIOR HIGH SCHOOLS (JHSs)
CRITERIA
1. The School is listed in
the Enhanced Basic
Education (EBEIS)
2. There is a need for the a.
JHS or IS to implement
SHS because:
a. No other school in the
division will offer the
same Track/Strand
the school will offer
b.
b. There is sufficient
number of learners to
warrant the
implementation of SHS
in the school, there
being no other school
to accommodate said
learners.
c.
However, this limitation
may be waived where
learners seeking
admission, as the case
may be, can no longer be
accommodated by the
existing public SHS due to
congestion, as justified
AND INTEGRATED SCHOOLS (ISs)
EVALUATION SHEET
REQUIRED DOCUMENTS
DepEd School Identification (ID)
Letter request for
implementation of SHS
program addressed to the
School’s Division
Superintendent (SDS).
Certification signed by the SDS
stating that no public SHS is
offering the same SHS Track
within the catchment area
Implementation Plan for the
SHS Program covering five (5)
years to include among others,
the following:
c.1 Current and projected
enrolment for five (5) school
years, by grade level;
REGION III
SCHOOLS DIVISION OFFICE OF BATAAN
REMARKS
PER EVALUATION (PASSED OR FAILED/
Pls. state reason, if failed)
Name of School : SAMPALOC INTEGRATED SCHOOL
DepEd School ID No. as presented : 501331
DepEd School ID No. as verified with : 501331
Planning and Research Unit
a. Request signed by : RONALD P. BANTUGAN, EdD
Position/Designation : School Principal I
Office/School : SAMPALOC INTEGRATED SCHOOL
Date : March 14, 2022
b. SHS Track to be Offered : HUMSS
Certification signed by : _________________________________________________________
Position/Designation : _______________________________________________________
Contents of Certification verified as correct YES ________ NO ________
Justification on the Need for Implementation of SHS : ___________________________________________
(in case, SHS will offer the same __________________________________________________________
track) __________________________________________________________
__________________________________________________________
IS Implementation Plan
c.1 No. of Prospective Enrollees :
Grade Level CURRENT PROJECTED
(SY__ to __)
Year 1 Year 2 Year 3 Year4 Year 5
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1. Proposed Budgetary
requirements for its
Personal Services,
Maintenance and other
Operarting Expenses, and
Capital Outlay;
2. Operational Plan re:
curriculum and the
instructional supervision
of the proposed SHS; and
3. School Site Development
Plan (SSDP) to include
proposed school
buildings, as needed.
d. Justification signed by the
SDS, in case will offer the
same SHS Track
a. Certification signed by the
3. The school has School Head, duly attested by
adequate facilities, the SDS on the excess
equipment and other classrooms, tables, chairs and
resources to support other resources to be used for
the operation of a SHS. the implementation of SHS
b. Inventory of Learning
TOTAL
c.2 Proposed Budgetary Requirements
Particulars Year 1 Year 2 Year 3 Year 4 Year 5 Supported w/ Breakdown
Yes No
Personal Services
MOOE
Capital Outlay
Total
c.3 Operational Plan Prepared By : _______________________________________________________
Position/Designation : _______________________________________________________
Office : _______________________________________________________
Date : _______________________________________________________
c.4 SSDP Prepared by : _______________________________________________________
Position/Designation : _______________________________________________________
Office : _______________________________________________________
Date : _______________________________________________________
d. Justification Signed By : _______________________________________________________
Position/Designation : _______________________________________________________
Office : _______________________________________________________
Date : _______________________________________________________
a. Certification Signed By : _______________________________________________________
Position/Designation : _______________________________________________________
Date : _______________________________________________________
Supported with Inventory YES _________ NO __________
b. Inventory of LRs prepared by : ___________________________________________________
Position/Designation : ___________________________________________________
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c.
d.
The school has
available space/site for
at least four (4)
classrooms considered
as excess or the
classrooms are still for
construction. The
classrooms built or to
be built be based on
the standards as a.
stipulated in DepEd
Education Facilities
Manual (i.e. 7m x 9m
classroom dimension).
Resources (LRs) prepared by Date : ___________________________________________________
the School’s Property Validated by : ___________________________________________________
Custodian, as validated by the Position/Designation/Office : ___________________________________________________
Schools Division Office Date : ___________________________________________________
Updated Personal Services c. Per PSIPOP for FY _________
Itemination and Plantilla of
Position of the concerned Particulars No. of Positions
school
a. School Head Item
b. No. of Teaching Items
c. No. of Support Staff
TOTAL
d. Updated Status Report Prepared By : _______________________________________________
Position/Designation : _______________________________________________
Date : _______________________________________________
Updated Status Report with
regard to the school’s existing
crucial resources Resources Needed
Particulars Amount
Personal Services
MOOE
Capital Outlay
TOTAL
Map, preferably drawn to scale, Map Certified By : ___________________________________________________________
showing the vacant lot where Position Designation : ___________________________________________________________
the proposed SHS Office : __________________________________________________________
classroom/school building will Date : __________________________________________________________
be constructed, duly certified by
the City/Municipal Engineer
No. of Excess/Available classrooms : ___________________________________________________
Existing classrooms compliant to standards : ___________________________________________________
Transcript of Records, Available school site
Certification of Relevant
Training, Service Record and a. Designated School Head has satisfied the DepEd CSC Qualification Standards of a School Head for Secondary
Civil Service eligibility of the School? YES _________ NO _________
proposed School Head, duly
certified as true copies by the
Schools Division Office’s
Records Unit.
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 Educational Preparation : ___________________________________________________________
b. Justification by the SDS, in
case the aforementioned Certified by DO
criterion is not met. Documents Submitted
Records Unit
YES NO
1. Transcript of Records
2. Certificates of Relevant Training
3. Service Record
4. Cs Eligibility

b. Justification, if any, duly signed by : ________________________________________________________

Position/Designation : _______________________________________________________
Date : _______________________________________________________
Reason(s) : ________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________

EVALUATED BY DIVISION REVIEW AND EVALUATION COMMITTEE (DREC):

MAR-ELEN FE G. REŇOSA, EdD MYLENE G. SANTOS ENGR. MERCK BRYAN GRAGASIN LOVELY LYN R. MALLARI
SDO COORDINATIOR FOR PRIVATE SCHOOLS/ BUDGET OFFICER ENGINEER III DIVISION PTA PRESIDENT
SHS FOCAL PERSON

PERLIE ANN R. TORRES RAMON C. PEREZ WILLIAM RODERICK R. FALLORIN

PLANNING OFFICER III SGOD CHIEF OIC-ASSISTANT SCHOOLS DIVISION SUPERINTENDENT

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RECOMMENDED BY:

ROLAND M. FRONDA, EdD, CESO VI

OIC-SCHOOLS DIVISION SUPERINTENDENT