Republic of the Philippines

Department of Education
Regional Office No. VIII (Eastern Visayas)
DIVISION OF LEYTE
Government Center, Candahug, Palo, Leyte

APPLICATION FOR PERMISSION TO STUDY

Name of Applicant: ROSELYN O. BAROÑA Position: TEACHER I

Civil Service Eligibility: Civil Status: SINGLE
Name of School where employed: ALANGALANG NATIONAL HIGH SCHOOL
Barrio:
Municipality: ALANGALANG, LEYTE Perm/Prov’l: PERMANENT
Distance in kms. between official station and college where enrolled:

EASTERN VISAYAS STATE UNIVERSITY, TACLOBAN CITY

(Name and Location of college where applicant wished to enroll)

Course applied for:

Academic Year: 2019 – 2020 Qtr./Sem. Summer: 2nd SEMESTER
Course to be taken this term and the schedule:

COURSE/SUBJECT DAYS OF THE WEEK HOURS OF THE WEEK

GRADUATE SEMINAR _SATURDAY________ 7:00 – 8:00 A.M.___

THESIS WRITING I _ SATURDAY _______ 8:00 – 9:00 A.M.___
ADOLESCENT PSYCHOLOGY __SATURDAY_______ 9:00 – 10:00 A.M.__

Credits or units towards - - - BSE MA Ed. D./Ph.D.

Total number of units previously ________ __0___ ___________
Number of units to be earned this Qtr./Sem./Summer ___________ 9___________________

I hereby certify that I have carefully read the information on the next page of this form, all the
provisions of which I am bound to observe very strictly, I understand that the regulations on the outside study
of teachers are intended to primarily safeguard the health of the teachers as well as of course to maintain
their efficiency in the service. I also understand that if in the opinion of the Division Superintendent of School
this study adversely affect my efficiency as a teacher this permission to study shall be revoked.

_______________________________
(Signature of Applicant)
Date Submitted: _______________________

APPROVAL RECOMMENDED:

The undersigned shall require strict compliance by the applicant with all the existing rules and
regulations regarding permission to study and should hold responsible for any undue delay in forwarding the
applicant to the office doing satisfactory work with an efficiency rating of “ABOVE AVERAGE” or higher. The
applicant will be required by me to submit through office, to the Division Superintendent a certified copy of the
report rating obtained in the course which should be attended to his/her outside study not earlier than thirty
minutes after the afternoon session in the public school.

Date Submitted: _______________________ _____________________________

District Supervisor/Sec. Sch.
Principal
APPROVED:
This permit expires on ______________________
Date: __________________
Permit No. ______________

RONELO AL K. FIRMO, Ph.D., CESO V

Schools Division Superintendent
APPLICATION FOR PERMISSION:

INSTRUCTIONS

1. Application for permission to study in five (5) copies must reach the office not later than two (2) months
before the start of the actual classes. THE TEACHERS JUST FILE REQUEST BEFORE ENROLLING FOR THE
FIRST TIME IN ANY SCHOOL, COLLEGE or UNIVERSITY.
2. The teacher applicant must be doing satisfactory work with an efficient rating of “ABOVE AVERAGE” or
higher.
3. The permission is given until the applicant complete the curriculum towards a degree. He does not need to
file a request for permission every semester.
4. A certificate from the head of the school or college where the teacher is enrolled and the subject to pursue
should be attached with the application.
5. Teachers who are about to finish course, or who have started a course as well as the subject already
completed and those still to be taken all to be certified by the Registrar of the private school concerned.
6. After each semester every teacher granted permission to study should submit to the Superintendent’s
Office, through channels, a certified true copy of the report on the ratings be obtained in the course which
he took during the semester including the number of units earned. In addition, as soon as he/she finished
a specific curricular towards a degree he/she should submit a complete set of his/her transcript of grades
and special order to the superintendent through his immediate superior for validation and verification.
7. The Maximum study of nine (9) units per semester or summer should be strictly observed. Teachers who
are candidates for graduation may be allowed to carry from (1) one to three (3) units more than the nine
(9) units authorized provided that those units are the last units that the teachers need to enable them to
graduate. No exemption will be given to the t teachers who do not fall under the above state condition.
Violation of this regulation on the study load shall be sufficient cause for revocation of the permission to
study for administrative action.
8. The college, school or university in which the teacher contemplates enrolling should be accessible to this
official station so that he will not be unduly complied to hurry there from in order to arrive at his class by
time. The teacher should attend to his outside study not earlier than thirty (30) minutes after the
afternoon session in the public school.
9. The immediate superior or supervisor shall be hold responsible for any undue delay in forwarding the
application to the superintendent, if the application to the superintendent has been filed on time.

ASIAN DEVELOPMENT FOUNDATION COLLEGE, TACLOBAN CITY

(Name and location of college where application wishes to enroll)

CERTIFICATION

TO WHOM IT MAY CONCERN:

This is to certify that ROSELYN O. BAROÑA, TEACHER I, is seeking admission in this college to (course)
___MAED with Specialization in Physical Education with the following subjects offered this __2nd SEMESTER__.

COURSE/SUBJECT DAYS OF THE WEEK HOURS OF THE DAY

GRADUATE SEMINAR __________________ 7:00 – 8:00 A.M.___

THESIS WRITING I __________________ 8:00 – 9:00 A.M.___
ADOLESCENT PSYCHOLOGY __________________ 9:00 – 10:00 A.M.__

___________________________ _____________________________
DEAN REGISTRAR

NOTE:
1. Weekdays classes in a semestral terms should not be earlier than 6:00 p.m.
2. Unless superseded by the DECS every term, a 3-unit lecture subject should be taken as follows:

SUMMER TERM – 1 ½ hours daily Monday through Saturday.

Maximum load; 9 units for all courses, 6 units in Law in prescribed subjects.
SEMESTRAL TERM – A total of three (3) hours a week. Maximum Load: 9 units for
Undergraduate course or 6 units of graduate level course except for enrollees
in Special Saturday Classes for maximum load not more than 6 units.