ISS - For Simulation Only

SUC LOGO/LETTERHEAD
SUC FACULTY POSITION RECLASSIFICATION

REQUEST FORM
PERSONAL INFORMATION
LAST NAME:
FIRST NAME, EXT.:
MIDDLE NAME:
HIGHEST EDUCATIONAL ATTAINMENT
NAME OF DEGREE:
NAME OF HEI:
YEAR GRADUATED:
CURRENT EMPLOYMENT STATUS
CURRENT FACULTY RANK:
MODE OF APPOINTMENT:
DATE OF APPOINTMENT:
NAME OF SUC:
CAMPUS:
ADDRESS:
Attached to this request form are my self-accomplished Individual Summary Sheet (ISS) and
its attached forms; checklist of evidence submitted; and photocopy of the sets of evidence
based on my ISS. The electronic copies of the ISS and the evidence are available in my
google drive that I will willingly share with the Evaluation Committees for the validation of the
information submitted.
I attest that all information provided in this request for position reclassification are true,
accurate and complete. I understand that any falsification of these documents may lead to my
disqualification from position reclassification for this evaluation cycle.
<Signature and Printed Name of Faculty>

<date signed>
I
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Form1_A
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A
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KRA I - INSTRUCTION S
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D
N
LAST NAME: 0 D
A
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LM
FIRST NAME, EXT.: 0 A
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E
MIDDLE NAME: 0 M
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N
1
CRITERION A - TEACHING EFFECTIVENESS (MAX = 60 POINTS) :A
sE
tM
X
1. FACULTY PERFORMANCE. Enter average rating received by the faculty/semester. For newly appointed faculty from private HEI, LUCs, E
T
TESDA/DepEd schools who still decided to proceed with the evaluation, put "0" in semesters with no student and supervisor's evaluation. :.
S
E
:
1.1 STUDENT EVALUATION (60%)
M
NUMBER OF SEMESTERS THAT WILL BE DEDUCTED FROM THE DIVISOR, IF APPLICABLE → 0 ###
### R
REASON FOR REDUCING THE DIVISOR NOT APPLICABLE <Link to Evidence from Google Drive>### a
### t
AVERAGE STUDENT EVALUATION RATING PER SEMESTER ### i
Evaluation Period Link to Evidence Link to Evidence n
1st SEMESTER 2nd SEMESTER V
from Google Drive from Google Drive g
A
a
a) AY 2019-2020 0.00 <Google Drive link> 0.00 <Google Drive link>
Ls
b) AY 2020-2021 0.00 <Google Drive link> 0.00 <Google Drive link> I
c) AY 2021-2022 0.00 <Google Drive link> 0.00 <Google Drive link> D
V
1
d) AY 2022-2023 0.00 <Google Drive link> 0.00 <Google Drive link> A
sa
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OVERALL AVERAGE RATING 0.00 E
i
FACULTY SCORE 0.00 D
dS
aE
1.2 SUPERVISOR'S EVALUATION (40%) R
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NUMBER OF SEMESTERS THAT WILL BE DEDUCTED FROM THE DIVISOR, IF APPLICABLE → 0
T
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REASON FOR REDUCING THE DIVISOR NOT APPLICABLE <Link to Evidence from Google Drive> Ia
N
A
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SUPERVISOR'S RATING PER SEMESTER G
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i
A
Evaluation Period Link to Evidence Link to Evidence C
nA
C
1st SEMESTER 2nd SEMESTER E
from Google Drive from Google Drive gC
V
C
A
P
aC
A
a) AY 2019-2020 0.00 <Google Drive link> 0.00 <Google Drive link> E
CLT
sEP
b) AY 2020-2021 0.00 <Google Drive link> 0.00 <Google Drive link> C
A
IT
P
E
c) AY 2021-2022 0.00 <Google Drive link> 0.00 <Google Drive link> B
V
D
A
T
P
d) AY 2022-2023 0.00 <Google Drive link> 0.00 <Google Drive link> LB
aA
A
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LlB
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OVERALL AVERAGE RATING 0.00 A
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E
B
dE
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FACULTY SCORE 0.00
La
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Prepared by: Evaluated by: e
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Name of Faculty and Signature Name of IEC Member and Signature N
Date: Date: G
Name of IEC Chair and Signature

Date:
Page 2 of 29
Form1_B&C
KRA I - INSTRUCTION
LAST NAME: 0
FIRST NAME, EXT.: 0
MIDDLE NAME: 0
CRITERION B - CURRICULUM AND INSTRUCTIONAL MATERIALS DEVELOPMENT (MAX = 30 POINTS)
1. FOR EVERY INSTRUCTIONAL MATERIAL DEVELOPED AND APPROVED FOR USE

1.1 SOLE AUTHORSHIP
Reviewer or Its Date Published Date Approved for Link to Evidence from Google
No. Title of Instructional Material Type of Instructional Material Publisher/ Repository Faculty Score
Equivalent (mm/dd/yyyy) Use (mm/dd/yyyy) Drive
1 SELECT OPTION 0.00 <Google Drive link>
TOTAL 0.00
1.2 CO-AUTHORSHIP
Note: Every IM with Multiple Authors should be Accompanied by a Certification using FORM I-B1a
Reviewer or Its Date Published Date Approved for % Contribution Faculty Link to Evidence from
No. Title of IM Type of IM Publisher/ Repository
Equivalent (mm/dd/yyyy) Use (mm/dd/yyyy) (write in decimal form) Score Google Drive
1 SELECT OPTION 0% 0.00 <Google Drive link>
TOTAL 0.00
Page 3 of 29
Form1_B&C
2. ACADEMIC PROGRAMS DEVELOPED/REVISED AND IMPLEMENTED

Name of Academic Degree Program Board Approval Academic Year Link to Evidence from Google
No. Type of Program Role Faculty Score
(provide complete name of the program) (Board Reso. No.) Implemented Drive
1 SELECT OPTION SELECT OPTION SELECT OPTION 0.00 <Google Drive link>
TOTAL 0.00
CRITERION C - THESIS, DISSERTATION AND MENTORSHIP SERVICES (MAX = 10 POINTS)
1. FOR SERVICES RENDERED TO STUDENTS AS:

1.1 ADVISER
NO. OF STUDENT ADVISEE Link to Evidence from Google
No. Requirement Faculty Score Drive
AY 2019-2020 AY 2020-2021 AY 2021-2022 AY 2022-2023
1 SPECIAL/CAPSTONE PROJECT 0 0 0 0 0.00 <Google Drive link>
2 UNDERGRADUATE THESIS 0 0 0 0 0.00 <Google Drive link>
3 MASTER'S THESIS 0 0 0 0 0.00 <Google Drive link>
4 DISSERTATION 0 0 0 0 0.00 <Google Drive link>
Total TOTAL 0.00
1.2 PANEL
NO. OF TIMES AS PANEL MEMBER Link to Evidence from Google
No. Requirement Faculty Score Drive
AY 2019-2020 AY 2020-2021 AY 2021-2022 AY 2022-2023
1 SPECIAL/CAPSTONE PROJECT 0 0 0 0 0.00 <Google Drive link>
2 UNDERGRADUATE THESIS 0 0 0 0 0.00 <Google Drive link>
3 MASTER'S THESIS 0 0 0 0 0.00 <Google Drive link>
4 DISSERTATION 0 0 0 0 0.00 <Google Drive link>
Total TOTAL 0.00
Page 4 of 29
Form1_B&C
2. FOR SERVICES RENDERED AS MENTOR

Name of the Academic Date Awarded Link to Evidence from Google
No. Name of Sponsor Organization Award Received Faculty Score
Competition (mm/dd/yyyy) Drive
1 0.00 <Google Drive link>
TOTAL 0.00
Prepared by: Evaluated by:
Name of Faculty and Signature Name of IEC Member and Signature

Date: Date:

Date:
Page 5 of 29
FACULTY POSITION RECLASSIFICATION FOR SUCs
KRA I - INSTRUCTION
SUMMARY OF POINTS
LAST NAME: 0
FIRST NAME, EXT.: 0
MIDDLE NAME: 0
CRITERION A - INSTRUCTION (MAX = 60 POINTS)

Faculty Score Allowable Points
1. FACULTY PERFORMANCE
1.1 Student Evaluation (60%) 0.00 ###
1.2 Supervisor's Evaluation (40%) 0.00
TOTAL POINTS FOR CRITERION A 0.00 0.00
CRITERION B - CURRICULUM AND INSTRUCTIONAL MATERIALS DEVELOPMENT (MAX = 30 POINTS)

1. INSTRUCTIONAL MATERIALS DEVELOPED AND APPROVED
1.1 Sole Authorship 0.00 ###
1.2 Co-Authorship 0.00
Sub-Total 0.00
2. ACADEMIC PROGRAM DEVELOPED/REVISED AND IMPLEMENTED 0.00
Sub-Total 0.00
TOTAL POINTS FOR CRITERION B 0.00 0.00
CRITERION C - THESIS, DISSERTATION AND MENTORSHIP SERVICES (MAX = 10 POINTS)

1. SERVICES RENDERED AS ADVISER, PANEL OR MENTOR Faculty Score Allowable Points
1.1 Adviser 0.00 ###
1.2 Panel 0.00
2.1 Mentor 0.00
Sub-Total 0.00
TOTAL POINTS FOR CRITERION C 0.00 0.00
GRAND TOTAL POINTS FOR KRA 1 (MAX - 100 points) 0.00 0.00
Conforme: Evaluated by:
Name and Signature Name of IEC Member and Signature

Date: Date:

Date:
Form2_A
KRA II - RESEARCH, INNOVATION AND CREATIVE WORK
LAST NAME: 0
FIRST NAME, EXT.: 0
MIDDLE NAME: 0
CRITERION A - RESEARCH OUTPUTS (MAX = 100 POINTS)
1. FOR EVERY SCHOLARLY RESEARCH PAPER/EDUCATIONAL OR TECHNICAL ARTICLE AND OTHER OUTPUTS PUBLISHED
1.1 SOLE AUTHORSHIP
International Date Published Link to Evidence from Google
No. Title of Research Output Type of Research Output Name of Journal / Publisher Reviewer or Its Equivalent Faculty Score
Indexing Body (mm/dd/yyyy) Drive
TOTAL 0.00
1.2 CO-AUTHORSHIP
International % Contribution
Reviewer or Equivalent Date Published Faculty Link to Evidence from
No. Title of Research Output Type of Research Output Name of Journal / Publisher Indexing Body (write in decimal
(if applicable) (mm/dd/yyyy) Score Google Drive
(if applicable) form)
Note: Every Research Output with Multiple Authors should be accompanied by a Certification using FORM II-A1a TOTAL 0.00 ###
Page 7 of 29
Form2_A
2. FOR EVERY RESEARCH OUTPUT TRANSLATED INTO PROJECT, POLICY OR PRODUCT AS:
2.1 LEAD RESEARCHER
Date implemented,
Date Completed Name of Project, Policy or Link to Evidence from Google
No. Title of Research Funding Source adopted or developed Faculty Score
(mm/dd/yyyy) Product Drive
(mm/dd/yyyy)
TOTAL 0.00
2.2 CONTRIBUTOR (should be accompanied by a Certification using FORM II-A2a)

Date implemented, % Contribution
Date Completed Name of Project, Policy or Faculty Link to Evidence from
No. Title of Research Funding Source adopted or developed (write in decimal
(mm/dd/yyyy) Product Score Google Drive
(mm/dd/yyyy) form)
1 0% 0.00 <Google Drive link>
TOTAL 0.00 ###
3. FOR EVERY RESEARCH PUBLICATION CITED BY OTHER AUTHORS

3.1 LOCAL AUTHORS (MAX = 40 POINTS)
Faculty Link to Evidence from
No. Title of Journal Article Date Published Name of Journal No. of Citation Citation Index Year of Citation
Score Google Drive
0 TOTAL 0.00 ###
Page 8 of 29
Form2_A
3.2 INTERNATIONAL AUTHORS (MAX = 60 POINTS)

No. Title of Journal Article Date Published Name of Journal No. of Citation Citation Index Year of Citation
Score Google Drive
TOTAL 0.00 ###
Name of Faculty and Signature Name of IEC Member and Signature

Date: Date:

Date:
Page 9 of 29
Form2-B
LAST NAME: 0
FIRST NAME, EXT.: 0
MIDDLE NAME: 0
CRITERION B - INVENTIONS (MAX = 100 POINTS)
1. FOR EVERY PATENDED INVENTION FOR

1.1 PATENTABLE INVENTIONS, UTILITY MODELS AND INDUSTRIAL DESIGNS PATE
1.1.1 INVENTION PATENTS I
SOLE INVENTOR N
V
Application Date Date Accepted, Published or Granted Link to Evidence from Google E
No. Name of the Invention Patent Application Stage Faculty Score
(mm/dd/yyyy) (mm/dd/yyyy) Drive N
1 SELECT OPTION 0.00 <Google Drive link> T
2 SELECT OPTION 0.00 <Google Drive link> I
O
N
5 SELECT OPTION 0.00 <Google Drive link> P
6 SELECT OPTION 0.00 <Google Drive link> A
7 SELECT OPTION 0.00 <Google Drive link> T
8 SELECT OPTION 0.00 E
<Google Drive link>
N
TOTAL 0.00 T
S
WITH MULTIPLE INVENTORS
Date Accepted, Published, or Granted % Contribution Faculty Link to Evidence from
No. Name of the Invention Date of Application Patent Application Stage
(mm/dd/yyyy) (write in decimal form) Score Google Drive
Note: should be accompanied by a Certification using FORM II-B1a TOTAL 0.00 ###
Page 10 of 29
Form2-B
1.1.2 UTILITY MODELS AND INDUSTRIAL DESIGNS

SOLE INVENTOR
Date of Application Date Granted Link to Evidence from Google
No. Name of Invention Type of Patent Faculty Score
(mm/dd/yyyy) (mm/dd/yyyy) Drive
TOTAL 0.00
Note:
shoul
WITH MULTIPLE INVENTORS
d be
acco Date of Application Date Granted % Contribution Faculty Link to Evidence from
No. Name of Invention Type of Patent
mpa (mm/dd/yyyy) (mm/dd/yyyy) (write in decimal form) Score Google Drive
1 nied SELECT OPTION 0% 0.00 <Google Drive link>
by a
Certif
3 icatio SELECT OPTION 0% 0.00 <Google Drive link>
4 n SELECT OPTION 0% 0.00 <Google Drive link>
5 using SELECT OPTION 0% 0.00 <Google Drive link>
6 FOR SELECT OPTION 0% 0.00 <Google Drive link>
M II-
B1a
Note: should be accompanied by a Certification using FORM II-B1a TOTAL 0.00 ###
1.2 COMMERCIALIZED PATENTED PRODUCTS

1.2.1 LOCAL (MAX = 20 POINTS)
Date Patented Date Product was first Commercialized Area/Place Faculty Link to Evidence from
No. Name of Patented Product Type of Product
(mm/dd/yyyy) (mm/dd/yyyy) Commercialized Score Google Drive
TOTAL 0.00 ###
Page 11 of 29
Form2-B
1.2.2 INTERNATIONAL (MAX = 30 POINTS)

Date Patented Date Product was first Commercialized Area/Place Faculty Link to Evidence from
No. Name of Patented Product Type of Product
(mm/dd/yyyy) (mm/dd/yyyy) Commercialized Score Google Drive
TOTAL POINTS TOTAL 0.00 ###
2. FOR EVERY NON-PATENTABLE INVENTION
2.1 COPYRIGHTED AND UTILIZED SOFTWARE PRODUCTS

2.1.1 NEW SOFTWARE PRODUCTS (COMPUTER PROGRAM)
SOLE DEVELOPER
Date Copyrighted Date Utilized Link to Evidence from Google
No. Name of the Software Name of End User/s Faculty Score
(mm/dd/yyyy) (mm/dd/yyyy) Drive
TOTAL 0.00
WITH MULTIPLE DEVELOPERS

Date Copyrighted Date Utilized % Contribution Faculty Link to Evidence from
No. Name of the Software Name of End-user
(mm/dd/yyyy) (mm/dd/yyyy) (write in decimal from) Score Google Drive
Note: should be accompanied by a Certification using FORM II-B1b TOTAL 0.00 ###
Page 12 of 29
Form2-B
2.1.2 UPDATED SOFTWARE PRODUCTS

SOLE DEVELOPER
Date Copyrighted Date Utilized Faculty Link to Evidence from
No. Name of the Software Contribution Specify New Features Name of End user/s
(mm/dd/yyyy) (mm/dd/yyyy) Score Google Drive
TOTAL 0.00 ###
2.2 NEW PLANT VARIETY OR ANIMAL BREEDS DEVELOPED/NEW MICROBIAL STRAINS ISOLATED THAT ARE PROPAGATED OR REPRODUCED
SOLE DEVELOPER
Name of Plant Variety, Animal Breed, Type (Plant, Animal or Date Completed Date Registered Date of Propagation Link to Evidence from Google
No. Faculty Score
or Microbial Strain Microbe) (mm/dd/yyyy) (mm/dd/yyyy) based on Certification Drive
TOTAL 0.00
WITH MULTIPLE DEVELOPERS

Name of Plant Variety, Animal Breed Type of Plant/Animal or Date Completed Date Registered Date of Propagation % Contribution Faculty Link to Evidence from
No.
or Microbial Strain Microbe (mm/dd/yyyy) (mm/dd/yyyy) based on Certification (write in decimal form) Score Google Drive
TOTAL 0.00 ###
D
Name and Signature Name of IEC Member and Signature a
Date: Date: t
e
:
D
Name of IEC Chair and Signature a
Date: t
e
Page 13 of :29
Form2_C
LAST NAME: 0
FIRST NAME, EXT.: 0
MIDDLE NAME: 0
CRITERION C - CREATIVE WORKS (MAX = 100 POINTS)
1. FOR EVERY CREATIVE WORK CREATED, PERFORMED. PRESENTED, EXHIBITED AND PUBLISHED
1.1 NEW CREATIVE PERFORMING ARTWORK (e.g. MUSIC, DANCE AND THEATRE)
Date Copyrighted / Date Faculty Link to Evidence from
No. Title of Creative Performing Art Type of Performing Art Classification Venue of Performance Organizer
Performed (mm/dd/yyyy) Points Google Drive
1 SELECT OPTION SELECT OPTION 0.00 <Google Drive link>
TOTAL 0.00 ###
1.2 EXHIBITION (e.g. VISUAL ART, ARCHITECTURE, FILM AND MULTIMEDIA)

Exhibition Date Faculty Link to Evidence from
No. Title of Creative Work Type of Creative Work Classification Venue of Exhibit Organizer
(mm/dd/yyyy) Points Google Drive
1 SELECT OPTION SELECT OPTION 1/1/2021 venue 01 organizer 01 0.00 <Google Drive link>
2 SELECT OPTION SELECT OPTION 1/19/2022 venue 02 organizer 02 0.00 <Google Drive link>
TOTAL 0.00 ###
Page 14 of 29
Form2_C
1.3 JURIED OR PEER-REVIEWED DESIGNS (e.g. ARCHITECTURE, ENGINEERING, INDUSTRIAL DESIGN)

Reviewer, Evaluator Activity/Exhibition Date Faculty Link to Evidence from
No. Title of Design Classification Venue of Activity/Exhibit Organizer
or Its Equivalent (mm/dd/yyyy) Points Google Drive
TOTAL 0.00 ###
1.4 LITERARY PUBLICATIONS (e.g. NOVEL, SHORT STORY, ESSAY AND POETRY)
Type of Literary Reviewer, Evaluator Date Published Faculty Link to Evidence from
No. Title of Literary Publication Name of Publication Name of Publisher/Press
Publication or Its Equivalent (mm/dd/yyyy) Points Google Drive
Equivalent Points TOTAL 0.00 ###

Date: Date:

Date:
Page 15 of 29

SUMMARY OF POINTS
LAST NAME: 0
FIRST NAME, EXT.: 0
MIDDLE NAME: 0
CRITERION A - RESEARCH OUTPUTS (MAX = 100 POINTS)
1. SCHOLARLY RESEARCHE PAPERS PUBLISHED Points Allowable Points

1.1 Sole Authorship 0.00 ###
1.2 Co-Authorship 0.00 ###
TOTAL POINTS 0.00 ###
2. RESEARCH OUTPUT TRANSLATED INTO PROJECT, POLICY OR PRODUCT

2.1 Lead Researcher 0.00 ###
2.2 Contributor 0.00 ###
3. RESEARCH PUBLICATION CITED

3.1 Local (MAX = 40 POINTS) 0.00 0.00
3.2 International (MAX = 60 POINTS) 0.00 0.00
CRITERION B - INVENTIONS (MAX = 100 POINTS)
1. PATENTED INVENTIONS Points Allowable Points

1.1 Patentable Inventions
1.1.1 Invention Patent
- Sole Inventor 0.00 ###
- Co-inventor 0.00 ###
1.1.2 Utility Model and Industrial Design
- Sole Inventor 0.00 ###
- Co-inventor 0.00 ###
1.2 Commercialized Patented Product
1.2.1 Local (Max = 20 points) 0.00 0.00
1.2.2 International (Max = 30 points) 0.00 0.00
2. NON-PATENTABLE INVENTIONS
2.1 Copyrighted and Utilized Software Products
2.1.1 New Software Products
a. Sole Developer 0.00 ###
b. Co-Developer 0.00 ###
2.1.2 Updated Software Products 0.00 ###
2.2 New Plant Variety, Animal Breed, New Microbial Strain
2.1.1 Sole Developer 0.00 ###
2.1.2 Co-Developer 0.00 ###
TOTAL POINTS FOR CRITERION B (MAX - 100 points) 0.00 0.00
Page 16 of 29
CRITERION C - CREATIVE WORKS (MAX = 100 POINTS)
1. CREATIVE WORKS PERFORMED, EXHIBITED, DESIGNED & PUBLISHED Points Allowable Points
1.1 Performing Arts 0.00 ###
1.2 Exhibitions 0.00 ###
1.3 Designs 0.00 ###
1.4 Literary Publication 0.00 ###
TOTAL POINTS FOR CRITERION C (MAX - 100 points) 0.00 0.00
GRAND TOTAL POINTS FOR KRA II (MAX - 100 points) 0.00 0.00
D
Name and Signature Name of IEC Member and Signature a
Date: Date: t
e
:
D
Name of IEC Chair and Signature a
Date: t
e
:
Page 17 of 29
Form III-A&B
KRA III - EXTENSION
LAST NAME: 0
FIRST NAME, EXT.: 0
MIDDLE NAME: 0
CRITERION A - SERVICE TO THE INSTITUTION (MAX = 30 POINTS)
1. FOR EVERY SUCCESSFUL LINKAGE, NETWORKING OR PARTNERSHIP ACTIVITY

MOA
Faculty role in the Activities conducted based on MOA Date of activity Faculty Link to Evidence from
No. Name of Partner Nature of Partnership Start Expiration
forging of partnership (not necessarily involving the faculty) (mm/dd/yyyy) Score Google Drive
(mm/dd/yyyy) (mm/dd/yyyy)
TOTAL 0.00 ###
2. TOTAL CONTRIBUTION TO INCOME GENERATION TOTA

Name of the Commercialized Product, Link to Evidence from Google
No. Role Total Amount Faculty Points
Funded Project, or Project with Industry Drive
TOTAL 0.00
Page 18 of 29
Form III-A&B
CRITERION B - SERVICE TO THE COMMUNITY (MAX = 50 POINTS)
1. PROFESSIONAL/EXPERTISE-BASED SERVICES
1.1 FOR SERVICES IN ACCREDITATION, EVALUATION, ASSESSMENT WORKS AND OTHER RELATED EDUCATION QA ACTIVITIES FOR
Appointment Period Faculty Link to Evidence from
No. Name of Agency/Organization QA-related Services Provided Scope No. of Deployment
Start End Points Google Drive
TOTAL 0.00 ###
1.2 SERVICES AS JUDGE OR EXAMINER FOR LOCAL/INTERNATIONAL RESEARCH AWARDS AND ACADEMIC COMPETITIONS SERV
Date of Event Faculty Link to Evidence from
No. Title of the Event/Activity Organizer Nature of the Award Venue
(mm/dd/yyyy) Points Google Drive
TOTAL 0.00 ###
Page 19 of 29
Form III-A&B
1.3 FOR SERVICES AS A SHORT-TERM CONSULTANT/EXPERT

Period of Engagement Faculty Link to Evidence from
No. Title of the Project/Consultancy Name of Organization Scope Role
Start End Points Google Drive
TOTAL 0.00 ###
1.4 SERVICES THROUGH MEDIA AS:

Title of Newspaper Column or Period of Engagement No. of Faculty Link to Evidence from
No. Services Name of Media
TV/Radio Program (mm/dd/yyyy to mm/dd/yyyy) engagements Points Google Drive
1.4.1 Writer of occasional newspaper column 0.00 <Google Drive link>
1.4.2 Writer of regular newspaper column 0.00 <Google Drive link>
1.4.3 Host of TV/Radio Program 0.00 <Google Drive link>
1.4.4 Guesting as technical expert for TV or radio program/print 0.00 <Google Drive link>
media/online media TOTAL 0.00 ###
1.5 FOR EVERY HOUR OF TRAINING COURSE, SEMINAR, WORKSHOP CONDUCTED AS A RESOURCE PERSON, CONVENOR, FACILITATOR, MODERATOR, KEYNOTE/PLENARY SPEAKER OR
PANELIST
Period of Engagement Faculty Link to Evidence from
No. Title of the Training Type of Participation Organizer Scope Total No. of Hours
start date end date Points Google Drive
TOTAL 0.00 ###
2. INSTITUTIONAL SOCIAL RESPONSIBILITY

Page 20 of 29
Form III-A&B
2.1 FOR EVERY SERVICE-ORIENTED PROJECT IN THE COMMUNITY PARTICIPATED, INCLUDING ADVOCACY INITIATIVES
No. of Activity Date Faculty Link to Evidence from
No. Name of Community Extension Activity Name of Community Role
Beneficiaries (mm/dd/yyyy) Points Google Drive
TOTAL 0.00 ###

Date: Date:

Date:
Page 21 of 29
KRA III - EXTENSION
LAST NAME: 0
FIRST NAME, EXT.: 0
MIDDLE NAME: 0
###
CRITERION C - QUALITY OF EXTENSION SERVICES (MAX = 20 POINTS)
###
CLIENT SATISFACTION RATING: Enter average rating received by the faculty/semester. For newly appointed faculty from private HEI, LUCs,
TESDA/DepEd schools who decided to proceed with the evaluation, put "0" in semesters with no client satisfaction rating.
###
SPECIFY NUMBER OF SEMESTERS THAT WILL BE DEDUCTED FROM THE DIVISOR, IF APPLICABLE → 0
###
REASON FOR DEDUCTING THE DIVISOR SELECT OPTION <Link to Evidence from Google Drive>
1. CLIENT SATISFACTION RATING FOR OUTREACH AND EXTENSION PROJECTS

CLIENT SATISFACTION RATING
No. Evaluation Period Link to Evidence
1st Semester Link to Evidence from Google Drive 2nd Semester
from Google Drive
1 AY 2019-2020 <Google Drive link> <Google Drive link>
OVERALL AVERAGE RATING 0.00
TOTAL FACULTY SCORE 0.00
CRITERION D - BONUS CRITERION (MAX = 20 POINTS)
1. FOR ADMINISTRATIVE DESIGNATION FOR A

1.1 HIGHEST ADMINISTRATIVE DESIGNATION HELD FOR AT LEAST ONE YEAR WITH THE EVALUATION PERIOD HIGH
Effectivity Period Link to Evidence

No. Designation Faculty Score
(mm/dd/yyyy to mm/dd/yyyy) from Google Drive
TOTAL ###
Prepared by: Evaluated by: Valida
Name and Signature Name of IEC Member and Signature Name

Date: Date:

Date:
KRA III - EXTENSION
SUMMARY OF POINTS
LAST NAME: 0
FIRST NAME, EXT.: 0
MIDDLE NAME: 0
CRITERION A - SERVICE TO THE INSTITUTION (MAX = 30 POINTS)

1. LINKAGES, NETWORKING AND PARTNESHIP 0.00 ###
2. CONTRIBUTION TO INCOME GENERATION 0.00 ###
CRITERION B - SERVICE TO THE COMMUNITY (MAX = 50 POINTS)

1. PROFEESIONAL EXPERTISE-BASED SERVICES Faculty Score Allowable Points
1.1 Accreditation, evaluation, assessment & other related educational QA activities. 0.00 ###
1.2 Judge/Examiner for local/international research awards and academic competitions 0.00 ###
1.3 For services rendered as a short-term consultant/expert 0.00 ###
1.4 Services through media
1.4.1 Writer of occasional newspaper column (Max = 10 points) 0.00 0.00
1.4.2 Writer of regular newspaper column 0.00 ###
1.4.3 Host of TV/Radio Program 0.00 ###
1.4.4 Guesting as technical expert for TV/radio program/print/online media (Max=10 pts) 0.00 0.00
1.5 For every hour of training/seminar/workshop conducted as Resource Person/Convenor/ 0.00 ###
Facilitator / Moderator/Keynote Speaker/Plenary Speaker/Panelist
TOTAL 0.00 ###
2. INSTITUTIONAL RESPONSIBILITY
2.1 For every service-oriented project in the community (including advocacy initiatives) 0.00 ###
CRITERION C - QUALITY OF EXTENSION (MAX = 20 POINTS)

1. CLIENT SATISFACTION RATING FOR OUTREACH AND EXTENSION ACTIVITIES 0.00 ###
TOTAL POINTS FOR CRITERION B (MAX = 20 points) 0.00 0.00
CRITERION D - BONUS CRITERION (MAX = 20 POINTS)

1. ADMINISTRATIVE DESIGNATION 0.00 ###
TOTAL POINTS FOR CRITERION C (MAX = 20 POINTS) 0.00 0.00
GRAND TOTAL POINTS FOR KRA III (MAX - 100 points) 0.00 0.00
###
Conforme: Evaluated by: Valid

Date: Date:

Date:
KRA IV - PROFESSIONAL DEVELOPMENT
LAST NAME: 0
FIRST NAME, EXT.: 0
MIDDLE NAME: 0
CRITERION A – INVOLVEMENT IN PROFESSIONAL ORGANIZATION (MAX = 20 POINTS)
1. FOR CURRENT INDIVIDUAL MEMBERSHIP AND ACTIVE ROLE/CONTRIBUTION IN PROFESSIONAL ORGANIZATION, LEARNED/HONOR/SCIENTIFIC SOCIETY
Activity of the organization Role or contribution to the activity Date of Activity Faculty Link to Evidence from
No. Name of Organization Type of Organization
participated by the faculty of the organization (mm/dd/yyyy) Score Google Drive
TOTAL 0.00 ###
CRITERION B – CONTINUING DEVELOPMENT (MAX = 60 POINTS)
1. EDUCATIONAL QUALIFICATIONS (MAX - 40 POINTS)
1.1 FOR DOCTORATE DEGREE (First Time)

Name of Doctorate Degree Name of Institution where the Date Completed Is the faculty Qualified for the Link to Evidence from Google
No. Faculty Score
(provide complete name of the program) degree was earned (mm/dd/yyyy) automatic 1 sub-rank increase? Drive
1 NO 0.00 <Google Drive link>
1.2 ADDITIONAL DEGREES

Date Completed Link to Evidence from Google
No. Degree Degree Name Name of HEI Faculty Score
(mm/dd/yyyy) Drive
TOTAL 0.00
2. FOR EVERY PARTICIPATION IN CONFERENCES, SEMINARS, WORKSHOPS, INDUSTRY IMMERSION (MAX = 10 POINTS)
Page 24 of 29
Date of Activity Link to Evidence from Google
No. Name of Conference/Training Scope Organizer Faculty Score
(mm/dd/yyyy) Drive
TOTAL 0.00
3. FOR EVERY PAPER PRESENTATION IN CONFERENCES (MAX = 10 POINTS)

No. Title of Paper Local or International Title of the Conference Conference Organizer Date Presented
Score Google Drive
TOTAL 0.00 ###

Date: Date:

Date:
Page 25 of 29
LAST NAME: 0
FIRST NAME, EXT.: 0
MIDDLE NAME: 0
CRITERION C – AWARDS AND RECOGNITION (MAX = 20 POINTS)
1. FOR EVERY AWARD OF DISTINCTION RECEIVED IN RECOGNITION OF ACHIEVEMENT IN RELEVANT AREAS OF SPECIALIZATION, PROFESSION AND/OR ASSIGNMENT OF THE FACULTY
CONCERNED.
Date the Award was Given Faculty Link to Evidence from

No. Name of the Award Scope of the Award Award-Giving Body/Organization Venue of the Award Ceremony
(mm/dd/yyyy) Score Google Drive
TOTAL 0.00 ###
CRITERION D – BONUS INDICATORS FOR NEWLY APPOINTED FACULTY (MAX = 20 POINTS)
1. FOR EVERY YEAR OF FULL-TIME ACADEMIC SERVICE IN AN INSTITUTION OF HIGHER LEARNING AS: FOR E
Period Covered Faculty Link to Evidence from
No. Designation/Position Name of HEI/s No. of Years
start end Score Google Drive
TOTAL 0.00 ###
2. FOR EVERY YEAR OF INDUSTRY EXPERIENCE (NON-ACADEMIC ORGANIZATION):

Page 26 of 29
Period Covered Faculty Link to Evidence from
No. Name of Company/Organization Designation/Position No. of Years
start end Score Google Drive
TOTAL 0.00 ###

Date: Date:

Date:
Page 27 of 29

SUMMARY OF POINTS
Name of Faculty: 0
Current Faculty Rank: 0
College/Department: 0
CRITERION A – INVOLVEMENT IN PROFESSIONAL ORGANIZATIONS (MAX = 20 POINTS)

Allowable
INDICATORS Faculty Score
Points
1. MEMBERSHIP AND ROLE/CONTRIBUTION IN ORGANIZATIONS, SCIENTIFIC SOCIETY, ETC. 0.00
CRITERION B - CONTINUING DEVELOPMENT (MAX = 60 POINTS)

Allowable
Points
1. EDUCATIONAL QUALIFICATION (MAX - 40 POINTS) 0.00 0.00
2. PARTICIPATION IN CONFERENCES, SEMINARS, WORKSHOPS, IMMERSIONS (Max = 10 POINTS) 0.00 0.00
3. PAPER PRESENTATION IN CENFERENCES (Max = 10 POINTS) 0.00 0.00
CRITERION C - AWARDS AND RECOGNITION (MAX = 20 POINTS)

Allowable
Points
1. AWARDS AND DISTINCTIONS RECEIVED 0.00
TOTAL POINTS FOR CRITERION C 0.00 0.00
CRITERION D - BONUS INDICATOR FOR NEWLY HIRED FACULTY (MAX = 20 POINTS)

Allowable
Points
1. ACADEMIC SERVICE IN HIGHER EDUCATION 0.00
2. INDUSTRY SERVICES (NON-ACADEMIC ORGANIZATIONS) 0.00
TOTAL POINTS FOR CRITERION D 0.00 0.00
GRAND TOTAL POINTS FOR KRA IV (MAX - 100 points) 0.00 0.00

Date: Date:

Date:
INDIVIDUAL SUMMARY SHEET
Name of Faculty: 0
Current Faculty Rank: 0
College/Department: 0
CRITERIA FACULTY SCORE

KRA I - INSTRUCTION (100 POINTS)
Criterion A – Teaching Effectiveness (60 points) 0.00
Criterion B – Curriculum and/or Instructional Materials Developed (30 points) 0.00
Criterion C – Special Proj., Capstone Proj., Thesis, Dissertation & Mentorship Services (10 points) 0.00
TOTAL 0.00
KRA II - RESEARCH, INNOVATION AND/OR CREATIVE WORK (100 POINTS)
Criterion A – Research Outputs Published (100 points) 0.00
Criterion B – Inventions (100 points) 0.00
Criterion C – Creative Works (100 points) 0.00
TOTAL 0.00
KRA III - EXTENSION SERVICES (100 POINTS)
Criterion A – Service to the Institution (30 points) 0.00
Criterion B – Service to the Community (50 points) 0.00
Criterion C – Quality of Extension Service (20 points) 0.00
Criterion D – Bonus Criterion (20 points) 0.00
TOTAL 0.00
KRA IV - PROFESSIONAL DEVELOPMENT (100 POINTS)
Criterion A – Involvement in Professional Organization (20 points) 0.00
Criterion B – Continuing Development (60 points) 0.00
Criterion C – Awards and Recognition (20 points) 0.00
Criterion D – Bonus Criterion (20 points) 0.00
TOTAL 0.00
KRA 1 KRA 2 KRA 3 KRA 4
Faculty Rank Total Points
Score Weight PTS Score Weight PTS Score Weight PTS Score Weight PTS
Instructor (I-III) 0.00 60% 0.00 0.00 10% 0.00 0.00 20% 0.00 0.00 10% 0.00 0
Asst. Professor (I-IV) 0.00 50% 0.00 0.00 20% 0.00 0.00 20% 0.00 0.00 10% 0.00 0
Assoc. Professor (I-V) 0.00 40% 0.00 0.00 30% 0.00 0.00 20% 0.00 0.00 10% 0.00 0
Professor (I-VI) 0.00 30% 0.00 0.00 40% 0.00 0.00 20% 0.00 0.00 10% 0.00 0
College/Univ. Prof. 0.00 20% 0.00 0.00 50% 0.00 0.00 20% 0.00 0.00 10% 0.00 0
Score Bracket No. of Sub-rank Increment Current Faculty Rank INSTRUCTOR II
41-50 1 sub-rank Qualified for Auto. 1-Sub Rank (for PhD)? NO
51-60 2 sub-rank Base Rank INSTRUCTOR II
61-70 3 sub-rank No. of Sub-Rank Increment based on Base Rank SELECT OPTION
71-80 4 sub-rank Initial Reclassified Rank (first computation) SELECT OPTION
81-90 5 sub-rank No. of Sub-Rank Increment based on Reclassified Rank SELECT OPTION
91-100 6 sub-rank Reclassified Rank (recomputation) SELECT OPTION
Qualified for Auto. 1-Sub Rank (for Awards)? NO
Final Faculty Rank SELECT OPTION
Conforme: Acknowledged by: Evaluated by:
Name and Signature Name and Signature Name and Signature of IEC
Date: Date: Date:

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SUC LOGO/LETTERHEAD

SUC FACULTY POSITION RECLASSIFICATION

<Signature and Printed Name of Faculty>

Name of IEC Chair and Signature

CRITERION B - CURRICULUM AND INSTRUCTIONAL MATERIALS DEVELOPMENT (MAX = 30 POINTS)

1. FOR EVERY INSTRUCTIONAL MATERIAL DEVELOPED AND APPROVED FOR USE

2. ACADEMIC PROGRAMS DEVELOPED/REVISED AND IMPLEMENTED

CRITERION C - THESIS, DISSERTATION AND MENTORSHIP SERVICES (MAX = 10 POINTS)

1. FOR SERVICES RENDERED TO STUDENTS AS:

2. FOR SERVICES RENDERED AS MENTOR

Prepared by: Evaluated by:

Name of Faculty and Signature Name of IEC Member and Signature

Name of IEC Chair and Signature

CRITERION A - INSTRUCTION (MAX = 60 POINTS)

CRITERION B - CURRICULUM AND INSTRUCTIONAL MATERIALS DEVELOPMENT (MAX = 30 POINTS)

CRITERION C - THESIS, DISSERTATION AND MENTORSHIP SERVICES (MAX = 10 POINTS)

Conforme: Evaluated by:

Name and Signature Name of IEC Member and Signature

Name of IEC Chair and Signature

KRA II - RESEARCH, INNOVATION AND CREATIVE WORK

CRITERION A - RESEARCH OUTPUTS (MAX = 100 POINTS)

2.2 CONTRIBUTOR (should be accompanied by a Certification using FORM II-A2a)

3. FOR EVERY RESEARCH PUBLICATION CITED BY OTHER AUTHORS

3.2 INTERNATIONAL AUTHORS (MAX = 60 POINTS)

Prepared by: Evaluated by:

Name of Faculty and Signature Name of IEC Member and Signature

Name of IEC Chair and Signature

KRA II - RESEARCH, INNOVATION AND CREATIVE WORK

CRITERION B - INVENTIONS (MAX = 100 POINTS)

1. FOR EVERY PATENDED INVENTION FOR

1.1.2 UTILITY MODELS AND INDUSTRIAL DESIGNS

1.2 COMMERCIALIZED PATENTED PRODUCTS

1.2.2 INTERNATIONAL (MAX = 30 POINTS)

2. FOR EVERY NON-PATENTABLE INVENTION

2.1 COPYRIGHTED AND UTILIZED SOFTWARE PRODUCTS

WITH MULTIPLE DEVELOPERS

2.1.2 UPDATED SOFTWARE PRODUCTS

WITH MULTIPLE DEVELOPERS

KRA II - RESEARCH, INNOVATION AND CREATIVE WORK

CRITERION C - CREATIVE WORKS (MAX = 100 POINTS)

1.2 EXHIBITION (e.g. VISUAL ART, ARCHITECTURE, FILM AND MULTIMEDIA)

1.3 JURIED OR PEER-REVIEWED DESIGNS (e.g. ARCHITECTURE, ENGINEERING, INDUSTRIAL DESIGN)

Prepared by: Evaluated by:

Name and Signature Name of IEC Member and Signature

Name of IEC Chair and Signature

KRA II - RESEARCH, INNOVATION AND CREATIVE WORK

CRITERION A - RESEARCH OUTPUTS (MAX = 100 POINTS)

1. SCHOLARLY RESEARCHE PAPERS PUBLISHED Points Allowable Points

2. RESEARCH OUTPUT TRANSLATED INTO PROJECT, POLICY OR PRODUCT

3. RESEARCH PUBLICATION CITED

CRITERION B - INVENTIONS (MAX = 100 POINTS)

1. PATENTED INVENTIONS Points Allowable Points

Conforme: Evaluated by:

KRA III - EXTENSION

CRITERION A - SERVICE TO THE INSTITUTION (MAX = 30 POINTS)

1. FOR EVERY SUCCESSFUL LINKAGE, NETWORKING OR PARTNERSHIP ACTIVITY

2. TOTAL CONTRIBUTION TO INCOME GENERATION TOTA

CRITERION B - SERVICE TO THE COMMUNITY (MAX = 50 POINTS)

1.3 FOR SERVICES AS A SHORT-TERM CONSULTANT/EXPERT

1.4 SERVICES THROUGH MEDIA AS:

2. INSTITUTIONAL SOCIAL RESPONSIBILITY

Prepared by: Evaluated by:

Name and Signature Name of IEC Member and Signature