Electronic CIC Forms: Revised CIC Accreditation Application and Documentary Requirements for SY 2022-2023

Republic of the Philippines

OFFICE OF THE OMBUDSMAN
Agham Road, Diliman, Quezon City
Ann
Annex “K”

Honorable SAMUEL R. MARTIRES

Ombudsman
Agham Road, Diliman, Quezon City

Re: APPLICATION FOR ACCREDITATION AS CAMPUS INTEGRITY

CRUSADERS (CIC) FOR SY 2022-2023

Dear Ombudsman Martires:

CDIS SUPREME STUDENT GOVERNMENT
The applicant, __________________________________________________________
(name of student organization),
COLONIA DIVINA INTEGRATED SCHOOL
____________________________________________________________________________
(name of school/college/university),
SCHOOL DIVISION OFFICE OF SAGAY CITY
_____________________________________________________________________________
DepEd Division / Place of College/University

through its President, _____________________________________________________, as duly

authorized representative, to this Honorable Office, respectfully applies for CIC accreditation for
School Year 2022-2023 to implement online CIC Project’s activities promoting integrity and
social responsibility using the online platform, with supporting electronic documentary
requirements per Section 4C of Memorandum Circular No. 04, Series of 2012:

1. Certificate of Recognition of organization issued by the School Principal/Dean of

Student Affairs;
2. List of organization’s officers;
3. Designation of organization’s Adviser by the Principal/Dean of Student Affairs;
4. Project Proposal to implement online activities for the School Year 2022-2023;and
5. Commitment of Support to implement online activities by the School Principal/Dean
of Student Affairs and Designated CIC Adviser

For your Honor’s consideration.

CDIS SUPREME STUDENT GOVERNMENT

__________________________________________
Name of the Organization

APPLE V. ODERIO
____________________________________________
President of Organization
(E-Signature over Printed Name)

Noted by:

JOHN ARGIEL L. VICTOR

_______________________________
Designated Adviser of Organization
(E-Signature over Printed Name)

_______________________________
JERRY C. ZARAGOZA
School Principal/Dean of Student Affairs
(E-Signature over Printed Name)
Electronic CIC Forms: Revised CIC Accreditation Application and Documentary Requirements for SY 2022-2023

Annex “K-1”

CERTIFICATE OF RECOGNITION

CDIS SUPREME STUDENT GOVERNMENT

This is to certify that _______________________________________________________
(name of organization)
is a duly recognized student organization of
COLONIA DIVINA INTEGRATED SCHOOL
____________________________________________________________________
(name of school/college/university)
SCHOOLS DIVISION OFFICE OF SAGAY CITY
____________________________________________________________________
Division of /Place of college/university
for School Year (SY) 2022-2023.

This Certification is issued for the abovenamed organization’s application for

accreditation as Campus Integrity Crusaders (CIC) of the Office of the Ombudsman for SY
2022-2023.

Issued this 21st of November, 2023.

JERRY C. ZARAGOZA
_____________________________________
School Principal/Dean of Student Affairs
(Signature over Printed Name)
Email address: jerry.zaragoza@deped.gov.ph
Electronic CIC Forms: Revised CIC Accreditation Application and Documentary Requirements for SY 2022-2023

Annex “K-2”

CDIS SUPREME STUDENT GOVERNMENT

___________________________________________________
(Name of Organization)

COLONIA DIVINA INTEGRATED SCHOOL

___________________________________________________
(Name of School/College/University)

SCHOOLS DIVISION OFFICE OF SAGAY CITY

___________________________________________________
(DepEd Division/Place of College/University)

LIST OF OFFICERS FOR SY 2022- 2023

POSITION NAME EMAIL FB ACCOUNT CP

ADDRESS NUMBE
R
PRESIDENT APPLE V. ODERIO applevoderio1485 https:// 9103728938
@gmail.com www.facebook.com/
applevoderio
VICE- KEISHA JENN B. MAHILOM mkeishajenn@gma https:// 9810050206
PRESIDENT il.com www.facebook.com/
profile.php?
id=100078966374635
SECRETARY MIKAELA EURIZE V. mikaelaeurize18@ https:// 9386341425
BUHAYAN gmail.com www.facebook.com/
profile.php?
id=100078457711243
TREASURER APRIL GRACE B. ALMODIEL aprilgracealmodiel https:// 9507879519
@gmail.com www.facebook.com/
aprilgrace.almodiel
AUDITOR TAKUMI S. YOSHIGA kumaerial@gmail. https:// 9464786356
com www.facebook.com/
hazme.ciazou
PIO CINDY MYLES C. BETITA betitacindy5@gma https:// 9076523110
il.com www.facebook.com/
cindymyles.betita.1
PEACE OFFICER NICASIO A. BUHAYAN III thirdyarcositas@g https:// 9606176294
mail.com www.facebook.com/
profile.php?
id=100077439647010

Submitted by:

APPLE V. ODERIO
_____________________________
President of Organization
(E-Signature over Printed Name)

Noted by:

JOHN ARGIEL L. VICTOR

_____________________
Adviser of Organization
(E-Signature over Printed Name)
Email address: johnargiel.victor@deped.gov.ph
FB Account: https://www.facebook.com/johnargielvictor/
CP Number: 09065556091
Electronic CIC Forms: Revised CIC Accreditation Application and Documentary Requirements for SY 2022-2023
Electronic CIC Forms: Revised CIC Accreditation Application and Documentary Requirements for SY 2022-2023

Annex “K-3”

Honorable SAMUEL R. MARTIRES

Ombudsman
Agham Road, Diliman, Quezon City

Re: Designation of Student-Organization’s Adviser

Dear Ombudsman Martires:

This is to JOHN ARGIEL

respectfully L. VICTOR
indorse Mr./Ms./Mrs.
_____________________________________,
CDIS SUPREME STUDENT GOVERNMENT
the designated Adviser of _________________________________________________________
(name of organization)
COLONIA DIVINA INTEGRATED SCHOOL
_________________________________________________________
(name of school/college/university),
SDO SAGAY CITY
Division of/Place of college/university _____________________________________________.

The designated Adviser/s will assist the mentioned organization in the implementation of
online activities as reflected in their Project Proposal in line with the extension of their
accreditation as Campus Integrit Crusaders of the Office of the Ombudsman for SY 2022-2023.

For your Honor’s consideration.

Respectfully yours,

JERRY C. ZARAGOZA
_________________________________
School Principal/Dean of Student Affairs
(E-Signature over Printed Name)
Electronic CIC Forms: Revised CIC Accreditation Application and Documentary Requirements for SY 2022-2023

Annex “K-4”

Name of Organization: CDIS SUPREME STUDENT GOVERNMENT

_______________________________________________
Name of School/College/University: COLONIA DIVINA INTEGRATED SCHOOL
_________________________________________
SDO SAGAY CITY
DepEd Division/Place of College/University:___________________________________

CIC ONLINE PROJECT PROPOSAL FOR SCHOOL YEAR 2022-2023

Title of Project Project PanaTAG

General Objective/s The project aims to:
1. Promote integrity and social responsibility by incorporating
the Three Acts of Goodness and DepEd Core Values
2. Promote honesty and encourage learners to save and give
value to coins especially the centavo coins.
3. Promote environmental awareness as one of our social
responsibility.

Online Activities
a. Promoting
Singko Para sa Lapis Ko Year 6: Save at Home Edition
Integrity
Description This is one of the flagship project of CDIS Supreme Student
Governement for 6 years. It started in 2017 where learners droped
and save their centavo coins in the coin bank inside the classroom.
When the pandemic strike the country, innovation was made to
continue this project. Instead of saving was done per section,
learners now save at their home. Learners will save the available
coins or centavo that they have and post an update in their social
media account. Learners will also encourage their family members
to drop their centavo coins. The collected coins afterwards will be
used to but pencils, pens and papers for all learners not only for
Colonia Divina Integrated School but also to Laon Elementary
School and Hamticon Elementary School.

Specific Objective This project aims to:

1. Collect the unused centavo coins for the pencils, pens and
papers of all learners
2. Practice thriftiness and honesty
3. Value centavo coins as a legal tender and a symbol of our
nation
Date and Time of Whole School Year
Conduct
Online Platform to be Facebook
used
Account Name and Acount Name: CDIS Supreme Student Government
Administrator Administrator: Apple Oderio, Keisha Jenn Mahilom, John Argiel L.
Victor

b. Promoting Social
Project PUNLA: Plant at Home
Responsibility
Description We do believe that environmental protection is the main social
responsibility of the human person. In 2017, SSG launched the
1000+ Marang Campaign and Tree Planting which aims to increase
the number of marang tree and to help in combating climate change.
During pandemic, this project did not stop, instead we make an
innovation where learners do a tree planting at home and this project
dubbed as 1000+ Marang Campaign and Tree Planting: Plant at
Home Edition. This 2022, the organization decided to change the
Electronic CIC Forms: Revised CIC Accreditation Application and Documentary Requirements for SY 2022-2023

name of the project into Project PUNLA: Plant at Home. PUNLA

stands for Pamayanang Umuunlad at Nagkakaisa para sa Luntiang
Adhikain. The changes was made to cater and to address the
following reasons:
1. The previous title of the project is just focusing on the single
type of seedling eventhough we also plant other fruit bearing
trees.
2. Aside from the tree planting activity, we also conduct clean
up drives and recycling activities.
3. We will conduct environmental education and DRRM
lessons in the community

To add more, Project PUNLA will start at home where learners and
the community will raise seedlings for tree planting, conduct home
gardening and backyard clean up. All activities done by the learners
and even community will be sent to the group chats and will be also
posted in their respected facebook accounts. If every community
will participate, we will truly achieve a true greener and sustainable
community.
Specific Objective Project PUNLA aims to:
1. Instill to the community the importance of environmental
protection as social responsibility
2. Raise and plant more trees, specifically fruit and native trees
for a greener future

Date and Time of Whole School Year

Conduct
Online platform to be Facebook
used
Account Name and Acount Name: CDIS Supreme Student Government
Administrator Administrator: Apple Oderio, Keisha Jenn Mahilom, John Argiel L.
Victor

In the implementation of our CIC Project’s online activities, we commit to comply with
all the requirements prescribed under Section 6 of Memorandum Circular No.2, Series of 2020
on the prohibition of in-person face-to-face activities, observance of online etiquettes and
submission of report of CIC activities implemented, among others.

Submitted by:

APPLE V. ODERIO
_________________________
President of Organization
(E-Signature over Printed Name)

JOHN ARGIEL L. VICTOR

________________________
Adviser of Organization
(E-Signature over Printed Name)

Noted by:

JERRY C. ZARAGOZA
_________________________________
School Principal/Dean of Student Affairs
(E-Signature over Printed Name)

Annex “K-5”
Electronic CIC Forms: Revised CIC Accreditation Application and Documentary Requirements for SY 2022-2023

LETTER OF COMMITMENT

JERRY C. ZARAGOZA
We,_________________________________________________________________,
School Principal/Dean of Student Affairs
COLONIA DIVINA INTEGRATED SCHOOL
of _____________________________________________________________
(Name of School/College/University)

JOHN ARGIEL L. VICTOR

and ____________________________________________________________________,
as Designated Adviser

CDIS SUPREME STUDENT GOVERNMENT

of ______________________________________________________________________
(Name of Organization),

SDO SAGAY CITY

Division of/Place of College/University________________________________________,
hereby commit to support the organization’s online activities as reflected in their Project
Proposal in line with their accreditation as Campus Integrity Crusaders of the Office of the
Ombudsman for SY 2022-2023.
21st day of November, 2022, Philippines.

JOHN ARGIEL L. VICTOR

___________________________________ JERRY C. ZARAGOZA
___________________________________
Adviser of Organization Principal/Dean of Student Affairs
(E-Signature over Printed Name) (E-Signature over Printed Name)
Electronic CIC Forms: Revised CIC Accreditation Application and Documentary Requirements for SY 2022-2023

Annex “L”

REPORT ON THE IMPLEMENTATION OF CIC ONLINE ACTIVITIES

FOR SY 2022-2023

Name of Organization:___________________________________ _______________________

Name of School/College/University:_______________________________________________
DepEd Division/Place of College/University_________________________________________
Title of CIC Project: ____________________________________________________________
General Objective/s: ____________________________________________________________

A. Name of Activity Specific No. of Participants Date(s) and Online Platform

Promoting Integrity Objective/s (specific no. supported Time of Used/Account
by Attendance)
Implementation Name and
Administrator

Narrative Description of the activity: (How the activity was implemented and how it helped promote a
culture of integrity and social responsibility among the students)
Benefit/Impact/Feedback of the project to the students/school/community: (What have the
participants learned from the activity and how has it influenced them in practicing integrity)
Strengths/Challenges/Limitations faced during the implementation (What were the strengths and
challenges/limitations in the implementation of the activity.)

B. Name of Activity/ies Specific No. of Participants Date(s) and Time Online Platform
Promoting Social Objective/s (specific no. supported of Used/Account
Responsibility by Attendance)
Implementation Name and
Administrator

Narrative Description of the activity: (How the activity was implemented and how it helped promote a
culture of integrity and social responsibility among the students)
Benefit/Impact/Feedback of the project to the students/school/community: (What have the
participants learned from the activity and how has it influenced them in practicing integrity)
Strengths/Challenges/Limitations faced during the implementation (What were the strengths and
challenges/limitations in the implementation of the activity.)

Please be informed that in the implementation of our CIC Project’s online activities, we
have complied with all the requirements prescribed under Section 6 of Memorandum Circular
No.___, Series of 2020 on the prohibition of in-person face-to-face activities, observance of
online etiquettes, among others.

Submitted by:

__________________________ ___________________________ _____________

CIC President CIC Adviser Date
(E-Signature over Printed Name) (E-Signature over Printed Name)

Noted by:

___________________________ _____________________________ ______________

AP Supervisor (Optional) School Principal/Dean of Student Affairs Date
(E-Signature over Printed Name) (E-Signature over Printed Name)