Republic of the Philippines

School
Department of Education Logo
REGION X – NORTHERN MINDANAO
Division of Misamis Oriental
(NAME OF SCHOOL)

APPLICATION FOR PERMIT TO STUDY

Name of Teacher/ Employee : _________________________________

Place of Employment/ School
Designation/Position
College/University to Enroll
School Year
M.A/PhD Program
: _________________________________
: _________________________________
: _________________________________
: _________________________________
: _________________________________

SUBJECTS UNITS NO. OF TIME DAY

HOURS

I hereby certify that my enrolment to Graduate Studies will not in any way
interfere with my official duties, and that I can still work for eight (8) hours per day as
required by Civil Service law.

________________________________________
Name & Signature of DepEd Employee

Noted by: Recommending Approval:

__________________________________ __________________________________
Name & Signature of School Head Name & Signature of PSDS

Action Taken: _______ Approve

_______ Disapprove due to _____________________________

EDILBERTO L. OPLENARIA, EdD, CESO V

Schools Division Superintendent