(PRIVATE SCHOOL) page 1 of 6

QA FORM 1

Republic of the Philippines

Department of Education
MIMAROPA REGION
Meralco Ave. cor. St. Paul Road,
Pasig City

REVISED PROCESSING SHEET

APPLICATION FOR NEW ESTABLISHMENT OF PRIVATE SCHOOL

Name of School :
School Address :
Courses Offered : ______________________________________________________________
School Year : ______________________________________________________________
Name of Sch. Head : ______________________________________________________________
Contact Number : ______________________________________________________________
Email Address : ______________________________________________________________
Date Received :
Date Released :

Particulars Quality Description Remarks

DO RO
Document Presentation Submitted 2 sets of documents (original and
photocopy of the original documents)
 Submitted to RO on or before August 30
preceding the start of the school year.
 Page finder descriptor tabs corresponding to the
numbers of documents in the checklist were
affixed accordingly to each document
 Colored expanding folder per division was
utilized.
 Calapan-Pink  Occi. Mdo - Red
 Palawan – Yellow  Or. Mdo - Orange
 Marinduque – Green  PPC - Blue
 Romblon – Purple
 Long expanding folders and papers (8.5”x13”)
were used.
 All documents were listed in a Table of Contents.
LIST OF DOCUMENTARY REQUIREMENTS AND ITS DESCRIPTION
1. Revised Processing  Duly accomplished and signed by the Division in-
Sheet charge of private schools
 No information was left out by the processor.
2. Inspection Report  Attachment B of QA FORM 1 was completely
filled out
 Contained Information corresponding to the actual
inspection conducted.
 Duly signed by the Division Inspectorate Team.

QAD/QAForm1/8.24.18
Quality Assurance Division (QAD) Tel. No. (02) 637-4184 Email Address: qad.depedro4b@gmail.com
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QA FORM 1
3. Endorsement  Duly signed by the SDS or his/her duly appointed
OIC
 Dated 7 working days prior to submission to RO.
 Consistent with the intended course/grade level as
stated in the Letter of Request or Board
Resolution
4. Application and  Supported by Official Receipt issued by the RO
Inspection Fee cashier in the amount of ₱2,020.00
__________OR Number
__________Date of payment
__________Name/designation of the person who
received the payment
5. School Bond  Supported by Official Receipt issued by the RO
cashier in the amount of Php 1,000.00
___________ Or Number
___________ Date of Payment
___________ Name/designation of person who
received the payment
6. Letter of Request or  Included the intended course/grade level to be
Board Resolution offered
 Duly signed by the members of the Board
 Notarized
7. Feasibility Study  Followed the prescribed format
 Observed the rules of technical writing
 Duly signed by the school owner
 Contained the following:
 Purpose and objectives of the proposed
school/course
 List/name(s) of schools offering the
same course within the locality and
the distance from the applicant
school
 Demand for the establishment of the
school (include the enrolment/ number of
enrollees in the existing nearby schools as
well as the facilities, standards and
supportive provisions for effective
instruction and quality of education)
 Adequacy of the school site
specifying the lot area
 One half (.5) hectare for a school with an
enrolment of 50 or less students;
 One (1) hectare for a school with an
enrolment of 50 to 1,000 students;
 Two (2) hectares for a school with an
Enrolment of 1,000 to 2,000 students.
 Documents of ownership (all in the
name of the school)
 Certificate of title in the name of
the school or Deed of Usufruct
 Total lot area ________________
 Floor area/size of classrooms
 Building Permit No., date issued,
QAD/QAForm1/8.24.18
Quality Assurance Division (QAD) Tel. No. (02) 637-4184 Email Address: qad.depedro4b@gmail.com
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QA FORM 1
place issued
 Sanitary Permit No., date issued,
place issued
 Business Permit No., date
issued, place issued
 DTI Permit No., date issued,
place issued
 Location Plan (in relation to any
recreational facilities and other factors
that may not be conducive to learning
 Campus Development and
Landscaping Plan
 Pictures (original)
 Architect’s Plan of the Building
Itemized cost of the project (site
development, physical facilities,
salaries, etc.)
 Financial capacity of the school to
sustain and maintain the school
(resources aside from tuition fees)
 Proposed faculty line-up,
administrative and supervisory staff
with corresponding qualifications and
intended salaries
8. Certificate of  DTI-registered in case of family-administered
Registration institution offering Kindergarten only
__________ Registration Number
________ to ________ Validity Period
 SEC-registered for stock/non-stock education
corporation
 Stock  Non-Stock
_________ to _________ Validity Period
_________ Number of Directors/Trustees
_________ Amount of capital stock
_________ share per trustee (sufficient to cater the
needs of the school for 1 year)
 Valid BIR registration certificate
 Valid SSS registration certificate
 Valid PhilHealth registration certificate
 Valid Pag-ibig registration certificate
9. Proposed Annual Budget  Annual Expenditures were itemized in terms of:
and Expenditures  Salaries
 Miscellaneous
 Capital Expenditures (building, property,
equipment)
 Annual Budget is adequate to cover Annual
Expenditures
 Dated corresponding to the school year applied for
 Duly signed by the school owner
10. Proposed Curriculum  Evaluated by the Curriculum Implementation
Division (CID) using the
Evaluation Sheet (Attachment A)
 Made notations if the following is compliant or
QAD/QAForm1/8.24.18
Quality Assurance Division (QAD) Tel. No. (02) 637-4184 Email Address: qad.depedro4b@gmail.com
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QA FORM 1
not:
 School Calendar
□ Conformed with the provisions of
DepEd Memo
□ With total number of days
□ With total number of holidays
□ Duly signed by the school head
 Class Program
□ Observed DepEd minimum
requirements on subjects offered
and their corresponding time
allotment
□ Corresponded to each class
□ Duly signed by the school head
 Teacher’s Program
□ Conformed with the class program
□ Indicated the current SY
□ Duly signed by the school head
 Evaluation sheet was signed by the EPS/PSDS and
noted by the CID Chief
11. Proposed Enrolment  Observed sex segregation by course/grade level
 Attained the minimum number of enrollees per
grade level (at least 10 per class)
12. Proposed Tuition and  Contained the following:
Other School Fees  Amount of tuition fee
 Other school fee such as:
 Registration fee
 Library Fee
 Athletic Fee
 Medical/Dental Fee
 Guidance Fee
 Audio Visual Room Fee
 ID
 Testing Materials
 School Organization Fee (Php 50.00)
 School Publication (Php 75.00)
 Laboratory Fee (Science)
 Laboratory Fee (Computer)
 Laboratory Fee (Voc./TLE)
 Capital Development Fee
 Indicated the total other school fees
 Indicated the grand total tuition and other school
fees
 Notarized
13. List of Academic and  Contained the following information:
Non-Academic  Names
Personnel  Educational qualifications and field of
specialization
 Transcript of Records
 Notarized Employment Contract
indicating the job description, salaries
and benefits and nature of appointment.
14. Retirement Plan  Registered with SEC or any related

QAD/QAForm1/8.24.18
Quality Assurance Division (QAD) Tel. No. (02) 637-4184 Email Address: qad.depedro4b@gmail.com
(PRIVATE SCHOOL) page 5 of 6
QA FORM 1
institution
15. School Policy on Anti-  Anchored on the DEPED Order No. 55, s. 2013
Bullying and Child  Duly signed by the school administrator
Protection
16. Facilities and  Enumerated by category:
Equipment  Athletic
 Laboratory
 Furniture and fixtures
 Educational Games
 Certified by the school head/administrator
 Indicated the total number of copies per textbook,
magazine, reference material and workbook per
learning area.
17. Instructional and  Listed by learning/subject area and by grade level
Learning Materials  Listed other reference materials
 Indicated the total number of copies of every
learning materials/references
18. Pictures  Copy for the Region must be original
 Included the following:
 School building(s)
 Classroom
 Restrooms
 Laboratories
 Library
 Medical and dental clinic
 Canteen
 Playground
 Stage
 Flagpole
 Principal’s Office
 Guidance Office
 Faculty Room
 Computer Room

Evaluated by:
SMME Secretariat

Counterchecked by:
SGOD Chief

Reviewed and validated:

Regional EPS In-Charge

QAD/QAForm1/8.24.18
Quality Assurance Division (QAD) Tel. No. (02) 637-4184 Email Address: qad.depedro4b@gmail.com
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QA FORM 1

Checked and verified:

QAD Chief

QAD/QAForm1/8.24.18
Quality Assurance Division (QAD) Tel. No. (02) 637-4184 Email Address: qad.depedro4b@gmail.com