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QA FORM 9
Republic of the Philippines
Department of Education
MIMAROPA Region
Meralco Ave. cor. St. Paul Road
Pasig City

REVISED PROCESSING SHEET

APPLICATION FOR ADDITIONAL GRADE LEVEL

Name of School : ____________________________________

Address of School : ____________________________________
School ID : ____________________________________
Courses Offered : Kindergarten Elem.
School Year : ____________________________________
Date Received : ____________________________________
Date Evaluated : ___________________________________ _
Date Released : ____________________________________
Contact Person : ____________________________________
Contact Numbers : ____________________________________
Email Address : ____________________________________

Particulars Quality Description Remarks

DO RO
Document Presentation  Submitted 2 sets of documents
(original and photocopies of the original documents)
 Submitted to RO within 1st week of July of the
current year
 Page finder descriptor tabs corresponding to the
numbers 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 Evaluation Duly accomplished and signed by the Division
Sheet Review and Evaluation Committee
No information was left out by the processor
2.Letter Request Addressed to the Schools Division Superintendent
(SDS) either from PTA or Barangay Council
Duly signed by the requesting officer,
designation/position and date of request
3.Feasibility Study Contained the following:
 Justification on the need for additional
grade level
 Proposed Organizational Structure
School Environment (Environmental
scanning/situational analysis) stating the
specified location/classification (Urban or Rural),
topography/geographical condition of the site
(Mountainous, Coastal, Plain), catchment area
as well as the mode of transportation in going
from home to school and vice versa
 School map showing the location of the building
for the additional grade level duly signed by the
Division Engineer.

Revised 9.18.18
Quality Assurance Division Tel No. (02) 637-4184/Telefax (02) 637-3093 Email Address: qad.depedro4b@gmail.com
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QA FORM 9
Duly signed by the School Head and Punong
Barangay and countersigned by the SMME
3. Division Inspection Template was completely filled out
Report COMPLIANT
PARTICULARS TO
STANDARD
YES NO
1.School Building/Classroom
2.No. of available classrooms, if
any
3. Size of school site in square
meters
Classrooms are built to be in accordance with the
existing DepEd standards, 7mx9m regardless of
class size
 Duly signed school site development plan
Included the following (if new building):
Duly signed building plan indicating the number
and technical specifications of the classrooms
Building design duly approved by the DepEd
Education Facilities Division, Administrative
Services
School building permit issued by the
Municipal/City Engineer
Duly signed Bureau of Fire (BFP) Certificate
4.List of Prospective Contained the following:
Enrollees Name segregated by sex
Age
Address
School currently enrolled
Attained the minimum number of enrollees (at
least 45 pupils/students)
Signed justification by the SDS if aforementioned
criterion was not met
8.School Site Complied lot size requirement of at least 5,000
Document square meters or one half (1/2) hectare for rural
areas; 2,500 square meters for highly urbanized
cities
Conformed to any one of the following
requirements:
Deed of Donation
 Duly signed by the donor and done (SDS)
and witnesses
 Duly accepted by the SDS as the done
 Notarized
Deed of Sale or Contract of Usufruct
 Duly signed by both contracting parties
 Land Title
 If tax declaration, attached certificate of no
pending land registration application from
the Registry of Deeds (ROD) or from the
Regional Trial Court (RTC)
 Type of land indicated in the Tax
Declaration like Timberland must be
converted into a school site and
Ancestral land in consultation with
the NCIP
 If public elementary to public secondary,
contracting parties are the school heads to be
confirmed by the SDS. Letter request to the
CO through the RO for the Deed of
confirmation to be signed by the SDS

Revised 9.18.18
Quality Assurance Division Tel No. (02) 637-4184/Telefax (02) 637-3093 Email Address: qad.depedro4b@gmail.com
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QA FORM 9
Duly signed justification by the SDS if
aforementioned criterion was not met
9.Memorandum of Duly signed by and between the SDS as DepEd
Agreement Representative and the Mayor or Provincial
Governor of LGU
Stated that the LGU or DepEd Office provides
funds for the following:
Construction of new school building/s (if there is
no building for the additional grade level/s
Procurement of educational facilities, furniture
and instructional materials
Duly signed certification that the Schools Division
Office has sufficient fund to cover resulting
expenses
Duly signed list of teacher/s to be assigned in the
additional grade level/s duly identified by the
respective item numbers per PSIPOP and name
of school, if any
Notarized

Evaluated by the Division and Evaluation Committee (DREC):

SMME Div. Admin. Officer Div. Planning

Officer

___________________ ____________________ ___________________

Division Accountant In-Charge of Education Facilities SGOD Chief

Validated by the Regional Inspectorate Team (RIT):

____________________ _______________________ ___________________

ENGR. DIEGO BUSTAMANTE WENDELL I. FORMALEJO, PhD. MELBERT S. BROQUEZA, PhD.
In-Charge, Education Facilities EPS, CLMD EPS, QAD

_______________________ ________________________ ____ __________________

RITCHIE G. DIOLA, PhD. ARDEE DC RAMILO ATTY. RENEE R. MORENO-PEREZ
EPS, QAD CAO, Finance Atty. IV, Legal Unit

__________________________
GLORIA M. CRUZ
Chief, QAD

__________________________
RUTH L. FUENTES, CESO V
OIC, Office of the Assistant Regional Director

Revised 9.18.18
Quality Assurance Division Tel No. (02) 637-4184/Telefax (02) 637-3093 Email Address: qad.depedro4b@gmail.com
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QA FORM 9

Revised 9.18.18
Quality Assurance Division Tel No. (02) 637-4184/Telefax (02) 637-3093 Email Address: qad.depedro4b@gmail.com