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JSepublic of tlJe �!Jilippino

�epartment of �bucation
MIMAROPA REGION
DIVISION OF PALAWAN

OFFICE OF THE SCHOOLS DIVISION SUPERINTENDENT

MEMORANDUM NO. ()J.q , S. 2020
TO SCHOOL HEADS/ PRINCIPALS/
TEA R - IN - CHARGE
!;

FROM NATIVIDAD P. BAYUBAY, Ph. D., CESO VI ,6-f.

Schools Division Superintendent
Office of the Schools Division Superintendent
SUBJECT Senior High School Amended Template of Memorandum of Agreement
and Forms for Submission
DATE February 12, 2020

To ensure that our Memorandum of Agreement (MOA) for Senior High School Work Immersion
program in conformity with the requirements of DepEd Order No. 30 s. 2017 (Guidelines for
Work Immersion), pertinent laws, and orders of concerned government agencies, it is hereby
required that each MOA should be in the prescribed form depending on the nature of the
authorized partner training agency:
a) For Local Government Unit:
Schools Division of Palawan - Legal Unit SHS MOA Immersion Form No. 2, v. 2
b) For Company, Single Proprietorship, or Partnership:
Schools Division of Palawan - Legal Unit SHS MOA Immersion Form No. 3, v. 2
c) For Cooperative or Non-Governmental Organization:
Schools Division of Palawan - Legal Unit SHS MOA Immersion Form No. 4, v. 2
Moreover, each MOA should contain the following attachments:
a) Transmittal:
Schools Division of Palawan - Legal Unit SHS MOA Immersion Form No. 1, v. 2
b) Acknowledgment:
Schools Division of Palawan - Legal Unit SHS MOA Immersion Form No. 5, v. 2
c) Parent Consent Form:
Schools Division of Palawan - Legal Unit SHS MOA Immersion Fom1 No. 6, v. 2
Before you appear in DepEd Palawan Division Office, please ensure that you have complied with
the above requirements.

For strict compliance.

OSDS/LU/URC
"It is easier to liui/i[strrmo cliilifmi tlian to repair6ro� men"

•
Frederick /)ou.glass

PEO Road, Barangay Bancao-Bancao, Puerto Princesa City

Tel.# (048) 433-6392 Fax# No. (048) 433.9935
Email add: palawan@deped.govcfill
Schools Division of Palawan ·- Legal Unit SHS MOA lmn1t0 rsion Form No. 1, v. 2

TRANSMITTAL
Submission of SHS Work Immersion Memorandum of Agreements (MOAs)
Category Number of MOA per
Category
MOAs for checking - LGU
MOAs for checking- Company, Single proprietorship,
Partnership
MOAs for checking - Cooperative and NGO

I I. Checklist for the necessary attachments

In the First page of every MOA Cate11;ory
a) Copy of business registration for private and for-profit partners or any of the following:
valid Mayor's Permit, DTI Registration, or BIR Certification of Registration.
b) Copy of SEC certificate of registration for corporations or non-stock, non-profit partners
(e.g. NGO) or cooperatives.
c) Certification from the School Head recognizing the parh1er as authorized training
agency.
d) For LGUs, copy of the Resolution / Ordinance authorizing the Barangay Chairman,
Mayor or Governor to enter into a MOA with the School as partner agency.
e) Duly notarized Special Power of Attorney for the representative of the private for-profit
partner if the proprietor in the Mayor's Permit is not the signatory party in the MOA. For
corporations/NGOs/ cooperatives, a Secretary's Certificate of the Board of Directors
authorizing the signatory from the corporation/ NGO/cooperative to enter into
agreements/contracts on behalf of the corporation/NGO/cooperative. lf the Secretary's
Certifica le caimot be obtained, make sure that the signatory for the
corporation/NGO/cooperative is the branch mai1ager.
f) List of Students, Teachers/Supervisors and Tracks offered
g) Document for Immersion Module / Schedule of Daily Activities
h) Signed Parental Consent Forms
i) Copy of Insurance Policy for the students

I II. Checklist as to the Form

a) Use of the proper MOA templates for the appropriate partner prescribed by the
Division (e.g. sole proprietor, cooperative, and corporation as per the Annexes of DO No.
30, s. 2017).
b) The signatory for a sole proprietorship is the registered owner in the Mayor's Permit.
For LGUs, the signatory must be the Barangay Chairman, Mayor or Governor or their duly
authorized representatives, as the case may be.
c) The signatory-parties and the witnesses signed every page of the MOA (except the
Acknowledgement Part).
d) Photocopies of valid government IDs of the signatory for the School and the partner or
representative of the Partner.
e) Drafted three (3) original copies of the MOA bearing the signatures of the signatories.

NOTE WELL: Before you appear in DepEd Palawan Division Office, please ensure that you have
complied with the above requirements. Also, please remember that only a Notary Public can

■
notarize the MOA. A Mayor or any other government official cannot notarize the document as
the said act is outside of his authority.

lcgalun1t.palawan(aldepc>d.gov.ph / https://www.f.1cebonk.con1/1uris.sect1on
 MEMORANDUM OF AGREEMENT
for Work Immersion Partnership

This Memorandum of Agreement is entered into by and between:

The <NAME OF SCHOOL>, with School Identification Number <SCHOOL ID Number>, a

public high school, with principal address at Barangay _____�-----�represented
in this Agreement by its Principal, Filipino citizen of legal age, and
herein after referred to as the "SCHOOL";

-and-

The <BARANGAY, MUNICIPALITY, OR PROOVINCE OF>, a Local Government Unit

existing under Philippine laws with office address at <Address of the LGU>, Palawan, represented in
this Agreement by its Local Chief Executive, <Name of the Bgy. Olairman, Municipal Mayor, or
Governor>, Filipino, of legal age, hereinafter referred to as the "LGU".

WITNESS ETH:

WHEREAS, the Department of Education of the Philippines, hereinafter referred to as

"DepEd", is the primary government instrumentality mandated to formulate, implement, and
coordinate policies, plans, programs and projects in the areas of formal and non-formal basic
education; supervise all elementary and secondary education institutions, including alternative
learning systems, both public and private; and provide for the establishment and maintenance of a
complete, adequate, and integrated system of basic education relevant to the goals of national
development;

WHEREAS, with the passage of the Enhanced Basic Education Act of 2013 or Republic Act
10533, the DepEd was tasked to implement the K to 12 Program, essentially adding two (2) years of
specialization within the Basic Educational System;

WHEREAS, the DepEd designed the implementation of RA 10533 within the framework of
increased community involvement in the learner's experience;

WHEREAS, with this premise, the DepEd, offers venues for various stakeholders to
participate in the implementation of RA 10533 and, the same offer, accepted by the parties herein;

WHEREAS, the DepEd has introduced the K to 12 basic education reform program that
includes Senior High School, hereinafter referred to as "SHS", with the major objective of ensuring
that graduates of basic education are ready for employment, entrepreneurship and higher learning;

WHEREAS, the SHS curriculum can be customized at the local levels to take into
consideration the needs of local industries and the labor market;

WHEREAS, the DepEd believes that for the effective delivery of SHS instruction, there is a
need for school-industry partnerships that will provide the school the necessary expertise and venue
for practical, on-the-job, enterprise-based training for SHS learners;

WHEREAS, the DepEd has started full implementation of SHS in 5<'.hool Year 2016-2017;

WHEREAS, the SCHOOL is among those that will offer SHS to students in the community to
carry out DepEd's objectives for SHS as spelled out above;

WHEREAS, to achieve this objective, the SCHOOL needs to enter into a Work Immersion
Partnership with the LGU;
Schools Divf:.:ion of P;,/awan - Legai Unit SHS MO.A 1rr·1r:-1er::i 1;;,n �orrn No, 2., v. )

WHEREAS, the LGU operates in the area where the School is located and has offices, facilities,
project sites, and expertise that it can make available to the School for purposes of student work
immersion;

WHEREAS, the LGU considers going into a work immersion partnership with the School as
part of its mission to create a positive impact on the community, especially the young people;

WHEREAS, the LGU is encouraged to fully support the successful implementation of the K
to 12 Program of the Department of Education as stated in Paragraph 4, Section 2 of the Republic Act
9155 or" Governance of Basic Education Act of 2001",

WHEREAS, the LGU recognizes the need for work immersion environment that is safe for the
students and teachers, and conducive to learning, and has the capability to provide these;

WHEREAS, the SCHOOL and the LGU, hereinafter collectively referred to as "the parties",
undertake to collaborate for the successful implementation of the SHS in this Barangay, Municipality,
or Province cognizant of the need for special protection of the child and with the best interest of the
SHS learner at heart;

NOW THEREFORE, for and in consideration of the f oregoing premises, the PARTIES
hereby agree as follows:

I. DESCRIPTION OF THE WORK IMMERSION PROGRAM

The Work Immersion Program is one of the course requirements for graduation. A SHS
student has to undergo work immersion in a business organization or establishment with work
requirements related to the specialization. Through work immersion, the students are exposed to and
are familiarized with the work-related environment related to their field oi specialization.

II. OBJECTIVES OF THE WORK IMMERSION PARTNERSHIP

The.Work Immersion Partnership has the following objectives:

1. To supplement the formal curriculum of the SHS program with special inputs coming from the LGU
experts and practitioners in order to make the SHS program aligned and consistent with work
standards;

2. To appreciate the importance and application of the principles and theories learned in school;

3. To enhance the students' technical knowledge and skills;

4. To develop in the students of the SHS program the knowledge and skills that are relevant to the
needs of the job market in the area;

5. To provide SHS students relevant learning experiences by giving them exposure to the actual
workplace setting;

6. To enrich students' skills in communications and human relations;

7. To develop good work habits, attitudes, appreciation and respect for work; and,

8. To form Work Immersion Parb1ership between SCHOOL and the LGU, the students, faculty, and
staff of the schools concerned will be allowed the use of and access to the LGU workplace and
equipment as part of their Work Immersion Program.

III. RESPONSIBILITIES OF THE PARTIES

A. Joint Responsibilities
Schools DivisiCJ!i of �);dawan - Lec.1/ Unit SHS MOA. 11:1rnersion rorrn No. 2, 1; 2

Both the SCHOOL and the LGU shall:

1. Create a joint working group that will prepare the action plan to operationalize the partnership;

2. Form a joint steering conunittee to monitor the progress of the partnership and to make sure that
the provisions of this Memorandum of Agreement (MOA) are met;

3. Adhere to all laws, memorandums and circulars especially those pertaining to child protection as
provided for in the Guidelines for Work Immersion;

4. Develop the Work Immersion module specifying goals and objectives, desired outcomes of the
program and how these outcomes will be achieved, also noting the specific knowledge, skills,
attitudes, and competencies that the student should acquire after completing the program;

5. Develop a Work Immersion Daily Schedule of Activities that will be followed by the student during
the whole duration of the work immersion in the herein Local Government; and,

6. Formulate local school work inunersion policies and guidelines on selection, placement, monitoring,
and assessment of students (inunersion participants), in order to ensure that each student is assigned
to an inunersion partner matched to l1is/her desired track, qualifications and aptitude.

B. Responsibilities of the School

TI1e SCHOOL shall:

1. Identify and indicate the SHS track/ s, strand/ s, and/ or specialization/ s which will be the subject
of the partnership;

2. Make the needed adjustments to contextualize the SHS subjects based on inputs coming from the
LGU;

3. Designate a person who will be in-<:harge of coordinating with the LGU and supervising the
activities of the students for the duration of the Work Immersion Program;

4. Provide insurance coverage during the Work lnunersion program;

5. Continue to exercise its Special Parental Authority under the Family Code over the Senior High
School student under inunersion in the premises of the partner;

6. Monitor each student's progress throughout the duration of the entire work inunersion program so
as to make sure that the tasks assigned to each student are meaningful, challenging, and applicable to
his/her particular programs and are able to maximize the quality of the learning experience;

7. Provide the LGU an evaluation tool for the students' inunersion performance;

8. Issue a final grade to the student upon completion of the requirements within a prescribed period.

9. Ensure that the student will adhere to the non- disclosure policies of the LGU as agreed to by the
School;

10. Provide signed Consent forms from the parents as applicable;

11. Provide the LGU a Certificate of Participation in the SHS program for whatever purpose it may
serve;

12. Execute a deed of acceptance as a way of recognizing and acknowledging the donation/ s received
from the LGU; and,
13. Review, facilitate and endorse the application of the LGU to avail of the tax incentives/exemption
as specified in the RA. 8525 otherwise known as The Adopt-A-School Act of 1998.

C. The LGU shall:

1. Assign a competent Immersion Coordinator from the LGU to liaise with the School and supervise
the students without prejudice to the special parental authority of the school, its administrators and
teachers for the duration of the work immersion program so as to ensure efficient implementation of
all stages of the program;

2. Provide inputs into the curriculum through the discussions or workshops that DepEd will organize;

3. Lend its expertise by making available its resident resource persons to provide training to the
students;

4. Allow the students to be deployed to the different sections/ departments/project sites of the LGU
based on the Work Immersion Daily Schedule of Activities;

5. Agree to the required number of hours of the immersion program set under the DepEd SHS
curriculum;

6. Provide immersion opportunities for <number of students> taking up <Track Taken by the
Students> track for <School Year>

7. Provide students with an orientation about the LGU, its line of business, and the work its employees
do, and expose them to the various stakeholders of the community in which the LGU operates for the
students to get a holistic understanding of its business;

8. Similarly ensure that students undergo training related to their course, and provide the students
with work or activities based on the activities listed in the prescribed template for the Immersion
Program Activities;

9. Make its workplace and facilities available to students, and shall similarly take all necessary action
to ensure the safety of students within their areas of operation at all times, which shall include, but
shall not be limited to, the provision for Personal Protective Equipment (PPE' s), if applicable. Ensure
that the students will not be exposed to hazardous materials and working environment throughout
the duration of the immersion;

10. Evaluate students' performance in the immersion venue by accomplishing provided evaluation
tool;

11. Issue a Certificate of Completion to the student trainees upon satisfactory compliance with all
requirements of the program;

12. Subject to the concurrence and approval of the Sangguniang bayan, the Local Government may
execute Deed/s of Donation in favor of the Department of Education for any and all completed work
immersion partnership projects; and,

13. Submit to the Adopt-A-School Program Secretariat all pertinent documents in support of the
amount specified/claimed for the tax exemption application of the LGU.

IV. EFFECTIVITY

This agreement shall hold for the duration of the <Academic School Year> and is renewable
every year. The LGU and the SCHOOL shall submit their intention for renewal of this agreement
through formal notice within thirty (30) days before the expiration of this Agreement.
Sthoo!s 0i\1i,;:on of P:1irlwan -- Leeai Unit SHS rv1Oi\ irnrncr:,ion Form No. 2, \,- 2

The LGU and the SCHOOL reserve their respective rights to terminate their participation in
the agreement through formal written notice within thirty (30) days before the effectivity of the
termination. Both parties shall turnover all deliverables agreed thereto in the Work Immersion
Program. Termination shall be subject to the mutual agreement between the parties.

A material breach of the Work Immersion Guidelines and/ or this MOA shall constitute a
ground for termination of the MOA, in whole or in part, by the aggrieved party, without prejudice to
other legal remedies.

V. LIABILITY

The school, its administrator and teachers exercising authority and supervision over the Senior
High School Student undergoing immersion in the premises of the partner may be held accountable
for the student's acts.

Each party shall answer for losses and damages arising from any accident, act, or omission
directly attributable to its fault or negligence, which may cause death or bodily injury to any persons,
or loss or dainage to property, by or on account of the performance of the respective obligations by
the parties pursuant to this Agreement. Such responsibility shall continue to remain that of the
responsible party's even after the termination of this agreement, if such losses and damages were
incurred during the effectivity of this agreement.

DepEd shall not be liable for opportunity losses of the LGU during the duration and after the
termination of this agreement.

VI. NON-DISCLOSURE PROVISION

It is expressly understood by DepEd and the students that all information on technology,
manufacturing process, process standards, quality assurance methodologies, quality standards,
production capabilities, raw material purchasing, marketing, finance, and all other related documents,
manuals, operational and technical matters that the LGU shall make available to them shall be used
for the sole purpose of student training. All of these matters are classified as confidential in nature
and proprietary to the LGU and thereby each student hereby undertakes to prevent transfer of such
information by any of its members to any party outside of the herein <Barangay, Municipality or
Province>.

VII. OWNERSHIP OF OUTPUT AND INTELLECTUAL PROPERTY

Intellectual properties developed by the student as part of his or her regular Work Immersion
duties in the LGU and their corresponding copyrights and/ or patents shall belong to the LGU.

Intellectual properties developed by the students outside of his or her regular Work
Immersion Duties in the LGU and their corresponding copyrights and or patents shall belong to the
student, even if the student used the time, facilities, materials of the LGU, unless otherwise stipulated
in a separate agreement between the student and his or her parent or guardian and the herein Local
Government Unit.

The above provisions shall apply in proportion to the intellectual properties developed by the
student in case intellectual property is jointly developed by the student with an employee or personnel
of the herein <Barangay, Municipality, or Province>, unless otherwise stipulated in a separate
agreement between the student and his or her parent or guardian and the herein <Barangay,
Municipality, or Province>.

VIII. OTHER PROVISIONS

It is expressly understood by the PARTIES that the LGU is not obliged to pay 'wage or salary
since there is no employer-employee relationship that exists. However, the LGU is not precluded from
Schools Divi::-ion ot Pa!awan - Lcga! Unit SH::, MOA irnnH:r 0,1crn ;:orm No_ 2 1 v. 2

providing the student with any monetary or financial assistance in the form of transportation fee, food
allowance, etc.

In determining the existence of an employer-employee relationship, the following elements

are considered: (1) the power to hire; (2) the payment of wages; (3) the power to dismiss, and (4) the
power to control the employee's conduct, with the control test generally assuming primacy in the
overall consideration.

IX. GENERAL PROVISIONS

1. RESCISSION CLAUSE. That in case of substantial breach or non-performance of any of the

obligations, this MOA may be rescinded before its term by either or both parties;

2. MODIFICATION CLAUSE. This Agreement shall not be changed, modified, terminated, or

discharged, in whole or in part, except by an instrument in writing signed by both parties thereto,
or their respective successors or assignees; and,

3. SEPARABILITY CLAUSE. In case any of the provision/ s of this MOA is/ are rendered invalid,
illegal or unenforceable, the validity, legality and enforceability of the remaining provisions shall
not in any way be affected or impaired thereby.

IN WITNESS WHEREOF, the parties have hereunto set their hands on this ___ day of
______ at-------------� Palawan, Philippines.

FOR THE SCHOOL: FORTHELGU:

School Principal/Other Responsible Person Barangay Chairman/ Mayor/Governor

Signed in the Presence of:

ERIC N. QUILLIP
<Position> Education Program Supervisor
<Designation> Division SHS Focal Person

NATIVIDAD P. BAYUBAY, CESO VI

Schools Division Superintendent
School Division of Palawan
 ACKNOWLEDGEMENT

Republic of the Philippines )

City/Municipality of________�)
Province of Palawan )

BEFORE ME, a Notary Public for and in ________ this day of

_________ personally appeared:

Government Issued ID
Name Date and Place Issued
No.

Made known to me to be the same persons who executed the foregoing instrument and who
acknowledged to me that the same is their free and voluntary act and deed.

This instrument refers to the Memorandum of Ab>reement (MOA) consisting of_ page/s
including the page in which this acknowledgement is written, signed by the parties including their
instrumental witnesses on each page thereof and sealed with my Notarial Seal.

WITNESS MY HAND AND NOTARIAL SEAL, on the date and place written above.

NOTARY PUBLIC

Doc. No. ---

PageNo. ___
Book No. ---
Series of ----
Schools Division of Palawan - Legal Unit SHS MO/i, Immersion Form No. 3, v. 2

Private Company/ Single Proprietorship/ Partnership

MEMORANDUM OF AGREEMENT FOR WORK IMMERSION PARTNERSHIP

This Memorandum of Agreement is entered into by and between:

The <NAME OF SCHOOL>, with School Identification Number ____a public high
school, with principal address at -----------� represented in this
Agreement by its <Position>, <Name>, Filipino, of legal age, and hereinafter referred to as
the SCHOOL;

-and-

<NAME OF COMPANY, SINGLE PROPRIETORSHIP, or PARTNERSHIP>, duly

constituted and registered in the Philippines, with principal address at
---------� represented in this Agreement by its <Position>, <NAME>,
<NATIONALITY>, of legal age, hereinafter referred to as the "<COMPANY, SINGLE
PROPRIETORSHIP, or PARTNERSHIP> ",

WITNESSETH:

WHEREAS, the Department of Education of the Philippines, hereinafter referred to as

"DepEd" ,is the primary government instrumentality mandated to formulate, implement, and
coordinate policies, plans, programs and projects in the areas of formal and non-formal basic
education; supervise all elementary and secondary education institutions, including
alternative learning systems, both public and private; and provide for the establishment and
maintenance of a complete, adequate, and integrated system of basic education relevant to
the goals of national development;

WHEREAS, the DepEd has introduced the K to 12 basic education reform program that
includes Senior High School, hereinafter referred to as "SHS", with the major objective of
ensuring that graduates of basic education are ready for employment, entrepreneurship and
higher learning;

WHEREAS, the SHS curriculum can be customized at the local levels to take into
consideration the needs of local industries and the labor market;

WHEREAS, the DepEd believes that for the effective delivery of SHS instruction, there is a
need for school-industry partnerships that will provide the school the necessary expertise
and venue for practical, on-the-job, enterprise-based training for SHS learners;

WHEREAS, the DepEd has started full implementation of SHS in School Year 2016-2017;

WHEREAS, the SCHOOL is among those that will offer SHS to students in the community
to carry out DepEd' s objectives for SHS as spelled out above;
Schools Division of Palawan - Legal Unit SHS MOA Immersion Form No 3, v. 2

WHEREAS, to achieve this objective, the SCHOOL needs to enter into a Work Immersion
Partnership with the <COMPANY, SINGLE PROPRIETORSHIP, or PARTNERSHIP>;

WHEREAS, the <COMPANY, SINGLE PROPRIETORSHIP, or PARTNERSHIP> operates in

the area where the School is located and has offices, facilities, project sites, and expertise that
it can make available to the School for purposes of student work immersion;

WHEREAS, the <COMPANY, SINGLE PROPRIETORSHIP, or PARTNERSHIP> considers

going into a work immersion partnership with the School as part of its mission to create a
positive impact on the community, especially the young people;

WHEREAS, the <COMPANY, SINGLE PROPRIETORSHIP, or PARTNERSHIP> may avail

of the revenue regulation no. 10 s. 2003 implementing the tax incentives provision of R.A.
8525 otherwise known as the Adopt-A- School Act of 1998;

WHEREAS, the SCHOOL and the <COMPANY, SINGLE PROPRIETORSHIP, or

PARTNERSHIP>, hereinafter collectively referred to as "the parties", undertake to
collaborate for the successful implementation of the SHS in <Municipality of> cognizant of
the need for special protection of the child and with the best interest of the SHS learner at
heart;

NOW, THEREFORE, for and in consideration of the foregoing premises, the PARTIES
hereby agree as follows:

DESCRIPTION OF THE WORK IMMERSION PROGRAM

With the passage of the Enhanced Basic Education Act of 2013 or Republic Act 10533, the
DepEd was tasked to implement the K to 12 Program, essentially adding two (2) years of
specialization within the Basic Educational System;

The DepEd designed the implementation of RA 10533 within the framework of increased
community involvement in the learner's experience;

With this premise, the DepEd, offers venues for various stakeholders to participate in the
implementation of RA 10533 and, the same offer, accepted by the PARTIESs herein;

The Work Immersion Program is one of the course requirements for graduation. A SHS
student has to undergo work immersion in a business organization or establishment with
work requirements related to the specialization. Through work immersion, the students are
exposed to and are familiarized with the work-related environment related to their field of
specialization. Specifically, the students are able to:

1. Gain relevant and practical industrial skills under the guidance of industry experts and
workers;

2. Appreciate the importance and application of the principles and theories taught in the
classroom;
Schools Division of Palawan •· Legal Unit SHS MO.l\ lmmers,on Form No. 3, v 2

3. Enhance their technical knowledge and skills;

4. Prepare them to meet the needs and challenges of employment, entrepreneurship, or

higher education after their graduation.

I. OBJECTIVES OF THE WORK IMMERSION PARTNERSHIP

The Work Immersion Partnership has the following objectives:

1. To supplement the formal curriculum of the SHS program with special inputs coming from
the <COMPANY, SINGLE PROPRIETORSHIP, or PARTNERSHIP> experts and
practitioners in order to make the SHS program aligned and consistent with work standards;

2. To develop in the students of the SHS program the knowledge and skills that are relevant
to the needs of the job market in the area;

3. To provide SHS students relevant learning experiences by giving them exposure to the
actual workplace setting.

4. To form Work Immersion Partnership between SCHOOL and the<COMPANY, SINGLE

PROPRIETORSHIP, or PARTNERSHIP>, the students, faculty, and staff of the schools
concerned will be allowed the use of and access to the <COMPANY, SINGLE
PROPRIETORSHIP, or PARTNERSHIP> workplace and equipment as part of their Work
Immersion Program.

II. RESPONSIBILITIES OF THE PARTIES

A. Joint Responsibilities

Both the SCHOOL and the <COMPANY, SINGLE PROPRIETORSHIP, or

PARTNERSHIP> shall:

1. Create a joint working group that will prepare the action plan to operationalize the
partnership.

2. Form a joint steering committee to monitor the progress of the partnership and to make
sure that the provisions of this Memorandum of Agreement (MOA) are met.

3. Adhere to all laws, memoranda and circulars pertaining to child protection.

4. Develop the students' Work Immersion module specifying goals and objectives,
desired outcomes of the program and how these outcomes will be achieved, also noting
the specific knowledge, skills, attitudes and competencies that the student should acquire
after completing the program.

5. Develop a Work Immersion Daily Schedule of Activities that will be followed by the
students during the whole duration of the Work Immersion Program.

6. Formulate local school work immersion policies and guidelines on selection,

Schools D1v1s1on of Palawan - Legal Unit SHS M0/1. Immersion Form No. 3. v 2

placement, monitoring, and assessment of students (immersion participants), in order to

ensure that each student is assigned to an immersion partner matched to his/her desired
track, qualifications and aptitude.

B. Responsibilities of the School

The SCHOOL shall:

1. Identify and indicate the SHS track/s, strand/s, and/or specialization/ s which will be
the subject of the partnership.

2. Make the needed adjustments to contextualize the SHS subjects based on inputs coming
from the <COMPANY, SINGLE PROPRIETORSHIP, or PARTNERSHIP>.

3. Designate a person who will be in-charge of coordinating with the <COMPANY,

SINGLE PROPRIEfORSHIP, or PARTNERSHIP> and supervising the activities of the
students for the duration of the Work Immersion Program.

4. Continue to exercise its Special Parental Authority under the Family Code over the
Senior High School student under immersion in the premises of the partner.

5. Monitor each student's progress throughout the duration of the entire work immersion
program so as to make sure that the tasks assigned to each student are meaningful,
challenging, and applicable to his/her particular programs and are able to maximize the
quality of the learning experience.

6. Provide the <COMPANY, SINGLE PROPRIETORSHIP, or PARTNERSHIP> an

evaluation tool for the students' immersion performance.

7. Issue a final grade to the student upon completion of the requirements within a
prescribed period.

8. Ensure that the student will adhere to the non- disclosure policies of the <COMPANY,
SINGLE PROPRIEfORSHIP, or PARTNERSHIP> as agreed to by the School.

9. Provide signed Consent forms from the parents as applicable.

10. Provide the <COMPANY, SINGLE PROPRIEfORSHIP, or PARTNERSHIP> a

Certificate of Participation in the SHS program for whatever purpose it may serve.

11. Execute a deed of acceptance as a way of recognizing and acknowledging the

donation/s received from the <COMPANY, SINGLE PROPRIETORSHIP, or
PARTNERSHIP>.

12. Review, facilitate and endorse the application of the COMPANY to avail of the tax
incentives/exemption as specified in the R.A. 8525 otherwise known as The Adopt-A­
School Act of 1998.
Schools Dtvts1on of Palawan - l.egal Urnt SHS MOA Immersion Form No. 3, v 2

C. The Company shall:

1. Assign a competent Immersion Coordinator from the <COMPANY, SINGLE

PROPRIETORSHIP, or PARTNERSHIP> to liaise with the School and supervise the
students without prejudice to the special parental authority of the school, its
administrators and teachers for the duration of the work immersion program so as to
ensure efficient implementation of all stages of the program.

2. Provide inputs into the CUITiculum through the discussions or workshops that DepEd
will organize.

3. Lend its expertise by making available its resident resource persons to provide training
to the students.

4. Allow the students to be deployed to the different sections/ departments/project sites

of the <COMPANY, SINGLE PROPRIETORSHIP, or PARTNERSHIP> based on the Work
Immersion Daily Schedule of Activities.

5. Agree to the required number of hours of the immersion program set under the DepEd
SHS curriculum.

6. Provide immersion opportunities for <number of students> students for School Year
2016-2017.

7. Provide students with an orientation about the <COMPANY, SINGLE

PROPRIETORSHIP, or PARTNERSHIP>, its line of business, and the work its employees
do, and expose them to the various stakeholders of the community in which the
<COMPANY, SINGLE PROPRIETORSHIP, or PARTNERSHIP> operates for the students
to get a holistic understanding of its business.

8. Similarly ensure that students undergo training related to their course, and provide the
students with work or activities that are varied and applicable to their field of study.

9. Make its workplace and facilities available to students, and shall similarly take all
necessary action to ensure the safety of students within their areas of operation at all
times, which shall include, but shall not be limited to, the provision for Personal
Protective Equipment (PPE's), if applicable. Ensure that the students will not be exposed
to hazardous materials and working environment throughout the duration of the
immersion.

10. Evaluate students' performance in the immersion venue by accomplishing provided

evaluation tool.

11. Issue a Certificate of Completion to the student trainees upon satisfactory compliance
with all requirements of the program.

12. Execute a deed of donation in favor of DepEd for the completed Work Immersion
Partnership.
Schools D1v1s1on of Palawan - i_egal U111t SHS MOA Immersion Form No. 3, v. 2

13. Submit to the Adopt-A-School Program Secretariat all pertinent documents in support
of the amount specified/ claimed for the tax exemption application of the <COMPANY,
SINGLE PROPRIETORSHIP, or PARTNERSHIP>.

III. EFFECTIVITY

This agreement shall hold for the duration of the <from year-to year> Academic School Year
and is renewable every year. The <COMPANY, SINGLE PROPRIETORSHIP, or
PARTNERSHIP> and the SCHOOL shall submit their intention for renewal of this agreement
through formal notice within thirty (30) days before the expiration of this Agreement.

The <COMPANY, SINGLE PROPRIETORSHIP, or PARTNERSHIP> and the SCHOOL

reserve their respective rights to terminate their participation in the agreement through
formal written notice within thirty (30) days before the effectivity of the termination. Both
parties shall turnover all deliverables agreed thereto in the Work Immersion Program.
Termination shall be subject to the mutual agreement between the parties.

IV. LIABILITY

The school, its administrator and teachers exercising authority and supervision over the
Senior High School Student undergoing inunersion in the premises of the partner may be
held accountable for the student's acts.

Each party shall answer for losses and damages arising from any accident, act, or omission
directly attributable to its fault or negligence, which may cause death or bodily injury to any
persons, or loss or damage to property, by or on account of the performance of the respective
obligations by the parties pursuant to this Agreement. Such responsibility shall continue to
remain that of the responsible party's even after the termination of this agreement, if such
losses and damages were incurred during the effectivity of this agreement.

DepEd shall not be liable for opportunity losses of the Company during the duration and
after the termination of this agreement.

V. NON-DISCLOSURE PROVISION

It is expressly understood by DepEd and the students that all information on technology,
manufacturing process, process standards, quality assurance methodologies, quality
standards, production capabilities, raw material purchasing, marketing, finance, and all other
related documents, manuals, operational and technical matters that the <COMPANY,
SINGLE PROPRIETORSHIP, or PARTNERSHIP> shall make available to them shall be used
for the sole purpose of student training. All of these matters are classified as confidential in
nature and proprietary to the <COMPANY, SINGLE PROPRIETORSHIP, or
PARTNERSHIP> and thereby each student hereby undertakes to prevent transfer of such
information by any of its members to any party outside of the <COMPANY, SINGLE
PROPRIETORSHIP, or PARTNERSHIP>.

VI. OTHER PROVISIONS

Schools D,v,s,on of Palawan -- i._egal Uni! SHS MOA Immersion Form No. 3, v. 2

It is expressly understood by the PARTIES that the <COMPANY, SINGLE

PROPRIETORSHIP, or PARTNERSHIP> is not obliged to pay wage or salary since there is
no employer-employee relationship that exists. However, the <COMPANY, SINGLE
PROPRIETORSHIP, or PARTNERSHIP> is not precluded from providing the student with
any monetary or financial assistance in the form of transportation fee, food allowance, etc.

In determining the existence of an employer-employee relationship, the following elements

are considered: (1) the power to hire; (2) the payment of wages; (3) the power to dismiss, and
(4) the power to control the employee's conduct, with the control test generally assuming
primacy in the overall consideration.

No employer-employee relationship exists between the student and the partner in work
immersion if all the following criteria are met:

1. The training, even though it includes actual operation of the employer's facilities, is
similar to training provided in an educational program;

2. The training is for the benefit of the student;

3. The student does not displace regular employees, and works under close supervision;

4. The students are not entitled to a job at the conclusion of the training period and are
free to take jobs elsewhere in the same field;

5. Any clinical training is performed under the supervision and direction of people who
are knowledgeable and experienced in the activity;

6. The training is general, and qualifies the student to work in any similar business. It is
not designed specifically for a job with the employer that offers the program;

7. The screening process for the immersion program is not the same as for employment,
and does not appear to be for that purpose. The screening only uses criteria relevant for
admission to an independent educational program; and

8. Advertisements, posting, or solicitations for the program clearly discuss education or

training, rather than employment, although employers may indicate that qualified
graduates may be considered for employment.

VI. GENERAL PROVISIONS

1. RESCISSION CLAUSE. That in case of substantial breach or non-performance of any of

the obligations, this MOA may be rescinded before its term by either or both parties;

2. MODIFICATION CLAUSE. This Agreement shall not be changed, modified, terminated,

or discharged, in whole or in part, except by an instrument in writing signed by both
parties thereto, or their respective successors or assignees; and,
Sc:hoois Division of Palawan -· Legal Unit SHS MOA Immersion Form No. 3, v. 2

3. SEPARABILITY CLAUSE. In case any of the provision/ s of this MOA is/ are rendered
invalid, illegal or unenforceable, the validity, legality and enforceability of the remaining
provisions shall not in any way be affected or impaired thereby.

FOR THE SCHOOL: <FOR THE COMPANY, SINGLE­

PROPRIETORSHIP, or PARTNERSHIP>:

<School Principal/Other Responsible Person> <Owner/ Manager /Other Authorized

Person>

Signed in the Presence of:

ERIC N. QUILLIP
<Position> Education Program Supervisor
<Designation> Division SHS Focal Person

NATIVIDAD P. BAYUBAY, CESO VI

Schools Division Superintendent
Schools Division of Palawan
Schools Division of Pa/awan -- if,sal Unit sH c, MO,� irnrnNc.ion Form No S, v ?

ACKNOWLEDGEMENT

Republic of the Philippines )

City/Municipality of_________ )
Province of Palawan )

BEFORE ME, a Notary Public for and in ________ this __ day of

_________ personally appeared:

Government Issued ID
Name Date and Place Issued
No.
'
!
'

Made known to me to be the same persons who executed the foregoing instrument and who
acknowledged to me that the same is their free and voluntary act and deed.

This instrwnent refers to the Memorandum of Agreement (MOA) consisting of_ page/s
including the page in which this acknowledgement is written, signed by the parties including their
instrumental witnesses on each page thereof and sealed with my Notarial Seal.

WITNESS MY HAND AND NOTARIAL SEAL, on the date and place written above.

NOTARY PUBLIC

Doc. No. ---

PageNo. ___
Book No. ---
Series of ----
Schools Div1s1on of Palawan -· Legal Unit SHS !\JiOA Immersion Form No 4. v 2

MEMORANDUM OF AGREEMENT FOR WORK IMMERSION PARTNERSHIP

This Memorandum of Agreement is entered into by and between:

The <NAME OF SCHOOL>, with School Identification Number _____.a public high
school, with principal address at-----------� represented in this Agreement
by its <Position>, <Name>, Filipino, of legal age, and hereinafter referred to as the SCHOOL;
-and-

<NAME OF COOPERATIVE or NGO>, with principal address at---------�

represented in this Agreement by its <Position>, <NAME>, <NATIONALITY>, of legal age, and
hereinafter referred to as the COOPERATIVE or NGO>.

WITNESSETH:

WHEREAS, the Department of Education of the Philippines, hereinafter referred to as "DepEd" ,is
the primary government instrumentality mandated to fonnulate, implement, and coordinate
policies, plans, programs and projects in the areas of formal and non-formal basic education;
supervise all elementary and secondary education institutions, including alternative learning
systems, both public and private; and provide for the establishment and maintenance of a
complete, adequate, and integrated system of basic education relevant to the goals of national
development;

WHEREAS, the DepEd has introduced the K to 12 basic education reform program that includes
Senior High School, hereinafter referred to as "SH..S'', with the major objective of ensuring that
graduates of basic education are ready for employment, entrepreneurship and higher learning;

WHEREAS, the SHS curriculum can be customized at the local levels to take into consideration
the needs of local industries and the labor market;

WHEREAS, the DepEd believes that for the effective delivery of SHS instruction, there is a need
for school-industry partnerships that will provide the school the necessary expertise and venue
for practical, on-the-job, enterprise-based training for SHS learners;

WHEREAS, the DepEd has started full implementation of SHS in School Year 2016-2017;

WHEREAS, the SCHOOL is among those that will offer SHS to students in the community to
carry out DepEd' s objectives for SHS as spelled out above;

WHEREAS, to achieve this objective, the SCHOOL needs to enter into a Work Immersion
Partnership with the <COOPERATIVE or NGO>;

WHEREAS, the <COOPERATIVE or NGO> operates in the area where the School is located
and has offices, facilities, project sites, and expertise that it can make available to the School for
purposes of student work immersion;

WHEREAS, the <COOPERATIVE or NGO> considers going into a work immersion

partnership with the School as part of its mission to create a positive impact on the commrmity,
especially the young people;

WHEREAS, the <COOPERATIVE or NGO> recognizes the need for a work immersion
 choo!s D1vis1on of Palawan - L.egal Unit SHS MOA !rnrners,on Forni No 4. v 2

environment that is safe for the students and teachers, and conducive to learning, and has the
capability to provide these;

WHEREAS, the SCHOOL and the <COOPERATIVE or NGO> , hereinafter collectively referred
to as "the PARTIES", undertake to collaborate for the successful implementation of the SHS in
<Municipality OF> cognizant of the need for special protection of the child and with the best
interest of the SHS learner at heart;

NOW, THEREFORE, for and in consideration of the foregoing premises, the PARTIES hereby
agree as follows:

DESCRIPTION OF THE WORK IMMERSION PROGRAM

With the passage of the Enhanced Basic Education Act of 2013 or Republic Act 10533, the DepEd
was tasked to implement the K to 12 Program, essentially adding two (2) years of specialization
within the Basic Educational System;

The DepEd designed the implementation of RA 10533 within the framework of increased
community involvement in the learner's experience;

With this premise, the DepEd, offers venues for various stakeholders to participate in the
implementation of RA 10533 and, the same offer, accepted by the PARTIES herein;

The Work Immersion Program is one of the course requirements for graduation. A SHS student
has to undergo work immersion in a business organization or establishment with work
requirements related to the specialization. Through work immersion, the students are exposed to
and are familiarized with the work-related environment related to their field of specialization.
Specifically, the students are able to:

1. Gain relevant and practical industrial skills under the guidance of industry experts and
workers;

2. Appreciate the importance and application of the principles and theories taught in the
classroon1;

3. Enhance their technical knowledge and skills;

4. Prepare them to meet the needs and challenges of employment, entrepreneurship, or higher
education after their graduation.

I. OBJECTIVES OF THE WORK IMMERSION PARTNERSHIP

The Work Immersion Partnership has the following objectives:

1. To supplement the formal curriculum of the SHS program with special inputs coming from the
<COOPERATIVE or NGO> experts and practitioners in order to make the SHS program
aligned and consistent with work standards;

2. To develop in the students of the SHS program the knowledge and skills that are relevant to
the needs of the job market in the area
C>U!UU/s Division of Palawan -· Legal Unit SHS MOA Immersion Forrn No. 4. v 2

3. To provide SHS students relevant learning experiences by giving them exposure to the actual
workplace setting.

4. To form Work Immersion Partnership between the SCHOOL and the <COOPERATIVE or
NGO> , the students, faculty, and staff of the schools concerned will be allowed the use of and
access to the <COOPERATIVE or NGO> workplace and equipment as part of their Work
Immersion Program.

II. RESPONSIBILITIES OF THE PARTIES

A. Joint Responsibilities

Both the SCHOOL and the <COOPERATIVE or NGO> shall:

1. Create a joint working group that will prepare the action plan to operationalize the
partnership.

2. Form a joint steering committee to monitor the progress of the partnership and to make
sure that the provisions of this Memorandum of Agreement (MOA) are met.

3. Adhere to all laws, memoranda and circulars pertaining to child protection.

4. Develop the students' Work Immersion module specifying goals and objectives, desired
outcomes of the program and how these outcomes will be achieved, also noting the specific
knowledge, skills, attitudes and competencies that the student should acquire after
completing the program.

5. Develop a Work Immersion Daily Schedule of Activities that will be followed by the
students during the whole duration of the Work Immersion inside the <COOPERATIVE or
NGO> .

6. Formulate local school work immersion policies and guidelines on selection, placement,
monitoring, and assessment of students (immersion participants), in order to ensure that each
student is assigned to an immersion partner matched to his/her desired track, qualifications
and aptitude.

B. Responsibilities of the SCHOOL

The SCHOOL, shall:

1. Identify and indicate the SHS track/ s, strand/ s, and/ or specialization/ s which will be the
subject of the partnership.

2. Make the needed adjustments to contextualize the SHS subjects based on inputs coming
from the <COOPERATIVE or NGO>.

3. Designate a person who will be in charge of coordinating with the <COOPERATIVE or

NGO> and supervising the activities of the students for the duration of the Work Immersion
Program.

4. Continue to exercise its Special Parental Authority under the Family Code over the
�d!ools Div1s1on of Palawan - Legal Unit SHS MOA Immersion Form No 4. v 2

Senior High School student under immersion in the premises of the partner.

5. Monitor each student's progress throughout the duration of the entire work immersion
program so as to make sure that the tasks assigned to each student are meaningful,
challenging, and applicable to his/her particular programs and are able to maximize the
quality of the learning experience.

6. Provide the <COOPERATIVE or NGO> an evaluation tool for the students' immersion
performance.

7. Issue a final grade to the student upon completion of the requirements within a prescribed
period.

8. Ensure that the student will adhere to the non- disclosure policies of the <COOPERATIVE
or NGO> as agreed to by the SCHCXJL.

9. Provide signed Consent forms from the parents as applicable.

10. Provide the <COOPERATIVE or NGO> a Certificate of Participation in the SHS

program for whatever purpose it may serve.

11. Execute a deed of acceptance as a way of recognizing and acknowledging the donation/s
received from the <COOPERATIVE or NGO>.

C. Responsibilities of the <CCXJPERATIVE or NGO>:

The <COOPERATIVE or NGO> shall:

L Assign a competent Immersion Coordinator from the <COOPERATIVE or NGO> to liaise

with the School and supervise the students without prejudice to the special parental authority
of the school, its administrators and teachers for the duration of the work immersion program
so as to ensure efficient implementation of all stages of the program.

2. Provide inputs into the curriculum through the discussions or workshops that DepEd will
organize.

3. Lend its expertise by making available its resident resource persons to provide training to
the students.

4. Allow the students to be deployed to the different sections/departments/ project sites of

the <COOPERATIVE or NGO> based on the Work Immersion Daily Schedule of Activities.

5. Agree to the required number of hours of the immersion program set under the DepEd SHS
curriculum.

6. Provide immersion opportunities for <number of students> students for School Year 2016-
2017.

7. Provide students with an orientation about the <COOPERATIVE or NGO>, its line of
business, and the work its employees do, and expose them to the various stakeholders of the
community in which the <COOPERATIVE or NGO> operates for the students to get a
 s Division ol Palawan - Legal Unit SHS MOA Immersion F"orrn No 4. v. 2

holistic understanding of its business.

8. Similarly ensure that students undergo training related to their course, and provide the
students with work or activities that are varied and applicable to their field of study.

9. Make its workplace and facilities available to students, and shall similarly take all necessary
action to ensure the safety of students within their areas of operation at all times, which shall
include, but shall not be limited to, the provision for Personal Protective Equipment (PPE's),
if applicable. Ensure that the students will not be exposed to hazardous materials and
working environment throughout the duration of the immersion.

10. Evaluate students' performance in the immersion venue by accomplishing provided

evaluation tool

11. Issue a Certificate of Completion to the student trainees upon satisfactory compliance with
all requirements of the program.

12. Execute a deed of donation in favor of DepEd for the completed Work Immersion
Partnership.

III. EFFECTIVITY

This agreement shall hold for the duration of the <from year-to year> Academic School Year and
is renewable every year. The <COOPERATIVE or NGO> and the SCHOOL shall submit their
intention for renewal of this agreement through formal notice within thirty (30) days before the
expiration of this Agreement.

The <COOPERATIVE or NGO> and the SCHOOL reserve their respective rights to terminate
their participation in the agreement through formal written notice within thirty (30) days before
the effectivity of the termination. Both parties shall turnover all deliverables agreed thereto in the
Work Immersion Program. Termination shall be subject to the mutual agreement between the
parties.

IV. LIABILITY

The school, its administrator and teachers exercising authority and supervision over the Senior
High School Student undergoing immersion in the premises of the partner may be held
accountable for the student's acts.

Each party shall answer for losses and damages arising from any accident, act, or omission
directly attributable to its fault or negligence, which may cause death or bodily injury to any
persons, or loss or damage to property, by or on account of the performance of the respective
obligations by the parties pursuant to this Agreement. Such responsibility shall continue to
remain that of the responsible party's even after the termination of this agreement, if such losses
and damages were incurred during the effectivity of this agreement.

DepEd shall not be liable for opportunity losses of the <COOPERATIVE or NGO> during the
duration and after the termination of this agreement.
 _ s Division of Palawan - Legal Unit SHS MO/.\ lrr,mersion Form No 4. v 2

V. NON-DISCLOSURE PROVISION

It is expressly understood by DepEd and the students that all information on technology,
manufacturing process, process standards, quality assurance methodologies, quality standards,
production capabilities, raw material purchasing, marketing, finance, and all other related
documents, manuals, operational and technical matters that the <COOPERATIVE or NGO>
shall make available to them shall be used for the sole purpose of student training. All of these
matters are classified as confidential in nature and proprietary to the <COOPERATIVE or NGO>
and thereby each student hereby undertakes to prevent transfer of such information by any of its
members to any party outside of the <COOPERATIVE or NGO>.

V. OTHER PROVISIONS

It is expressly understood by the PARTIES that the <COOPERATIVE or NGO> is not obliged to
pay wage or salary since there is no employer-employee relationship that exists. However, the
<COOPERATIVE or NGO> is not precluded from providing the student with any monetary or
financial assistance in the form of transportation fee, food allowance, etc.

In determining the existence oi an employer-employee relationship, the following elements are

considered: (1) the power to hire; (2) the payment of wages; (3) the power to dismiss, and (4) the
power to control the employee's conduct, with the control test generally assuming primacy in the
overall consideration.

No employer-employee relationship exists between the student and the partner in work
immersion if all the following criteria are met:

1. The training, even though it includes actual operation of the employer's facilities, is
similar to training provided in an educational program;

2. The training is for the benefit of the student;

3. The student does not displace regular employees, and works under close supervision;

4. The students are not entitled to a job at the conclusion of the training period and are
free to take jobs elsewhere in the same field;

5. Any clinical training is performed under the supervision and direction of people who
are knowledgeable and experienced in the activity;

6. The training is general, and qualifies the student to work in any similar business. It is
not designed specifically for a job with the employer that offers the program;

7. The screening process for the immersion program is not the same as for employment,
and does not appear to be for that purpose. The screening only uses criteria relevant for
admission to an independent educational program; and

8. Advertisements, posting, or solicitations for the program clearly discuss education or

training, rather than employment, although employers may indicate \hat qualified
graduates may be considered for employment.
�ch:o's D1v1s1on of Palawan -- Legal Unit SHS MOA Immersion Form No 4. v 2

VI. GENERAL PROVISIONS

1. RESCISSION CLAUSE. That in case of substantial breach or non-performance of any of the

obligations, this MOA may be rescinded before its term by either or both parties;

2. MODIFICATION CLAUSE. This Agreement shall not be changed, modified, terminated, or

discharged, in whole or in part, except by an instrument in writing signed by both parties
thereto, or their respective successors or assignees; and,

3. SEPARABILITY CLAUSE. In case any of the provision/s of this MOA is/are rendered
invalid, illegal or unenforceable, the validity, legality and enforceability of the remaining
provisions shall not in any way be affected or impaired thereby.

FOR THE SCHOOL: <FOR THE COMPANY, SINGLE­

PROPRIETORSHIP, or PARTNERSHIP>:

<School Principal/ Other Responsible Person> <Owner/ Manager/ Other Authorized Person>

Signed in the Presence of:

ERIC N. QUILLIP
<Position> Education Program Supervisor
· <Designation> Division SHS Focal Person

NATIVIDAD P. BAYUBAY, CESO VI

Schools Division Superintendent
Schools Division of Palawan
 Division of PJ!awan - Leg,d Unit SW, rv!OA Immersion Form No.\ v. 2

ACKNOWLEDGEMENT

Republic of the Philippines )

City/Municipality of._________ )
Province of Palawan )

BEFORE ME, a Notary Public for and in -------� this __ day of

_
_ __ _____ personally appeared:

Government Issued ID
Name Date and Place Issued
No.

Made known to me to be the same persons who executed the foregoing instrument and who
acknowledged to me that the same is their free and voluntary act and deed.

This instrument refers to the Memorandum of Agreement (MOA) consisting of_ page/s
including the page in which this acknowledgement is written, si gned by the parties including their
instrumental witnesses on each page thereof and sealed with my Notarial Seal.

WITNESS MY HAND AND NOTARIAL SEAL, on the date and place written above.

NOTARY PUBLIC

Doc. No. ---

Page No. ---
Book No. ---
Series of ----
 •
Schools Oivi��ion of Prilawan - LegJi Unit SHS MO/\ irnrner (,ion �orm No. 6: v. 2

�epublic of tlJe .t)IJilippine�

1.!Bepartment of <fbucation
MIMAROPA REGION
DIVISION OF PA LAWAN
(NAME OF IDGH SCHOOL)
(Location)

PAHINTULOT NG MAGULANG / TAGAPATNUBAY

Ako si bilang magulang / tagapatnubay ni

(Kumpletong pangalan)
ng ay
(Pangalan ng mag-aaral) (Taon at Pangkat)
nagbibigay pahintulot na siya ay lumahok sa WORK IMMERSION PROGRAM ng Senior High School kung saan ang mga

mag-aaral ay ipapadala sa _______________ _________

(Pangalan at Address ng Partner
_______ ______ __ __ upang magtrabaho na may 1ayunin na larong ma/inang ang kanilang

kakayahan.

Nauunawaan ko ang kahalagahan ng programang ito at nababatid ko ang mga paghahandang ginawa ng mga

kawani ng paaralan upang gawing ligtas ang mga mag-aaral sa abot ng kanilang makakaya.

Akin rin pong ipinapaalam sa paaralan at sa mga kawani nito na ang aking anak ay walang sakit o medical

condition at kung mayroon man po, ito ay ang mga sumusunod, patina rin ang mga kaukulang gamut/lunas na dapat ay

maibigay sa bata: ______________________

Batid ko po na ang ang paaralan ay hindl aako ng responsibilidad sa mga insidente na gawa ng kapabayaan o

intensyonal na gawain ng estudyante o ng ibang partido maliban sa mga kawani ng paaralan at ng WORK IMMERSION

PROGRAM Partner.

Nauunawaan ko rin na walang responsibilidad ang Partner ng paaralan sa WORK IMMERSION PROGRAM na

bigyan ng sahod ang mag-aaral na lalahok dito dahil siya ay hindi naman itinuturing empleyado ng Partner habang ang

WORK IMMERSION PROGRAM ay ginagawa.

Sa pamamagitan ng aking pag-lagda sa Consent Form na ito ay aking pinatotohanan na ang paaralan at kanyang

mga kawani ay naipaliwanag sa akin ang mga probisyon ng DO 30, s. 2017 {Guidelines for Work Immersion) na

nagsusulong sa interest ng aking anak/sanggalang.

Pangalan at Lagda ng Magulang/Tagapatnubay Pangalan at Lagda ng Mag-aaral

Contact no. -------------

Work Immersion Teacher SHS Focal Person

Principal