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Bpsu Local Off Campus Activity Template
Bpsu Local Off Campus Activity Template
Bpsu Local Off Campus Activity Template
CERTIFICATE OF COMPLIANCE
This is to certify that all the processes, procedures and requirements before the conduct of the
off-campus activity/ies pursuant to CMO No. 63, series of 2017 entitled “Policies and Guidelines
on Local Off-Campus Activities” have been duly complied with, and that by virtue thereof, we
hereby assume full responsibility for the safety and welfare of the students.
Doc. No. ;
Page No. ;
Notary Public
Book No. ;
Series of ;
Letterhead of the Campus
REPORT OF COMPLIANCE
(This should be accomplished PRIOR to the conduct of the activity)
Campus : ________________________________________________________
Address : ________________________________________________________
BASIC INFORMATION:
List of
Destination/s Inclusive Number of
Program Name Course Personnel-in-
and Venue Dates Student
Charge
Compliance
Activities
Yes No Remarks
1. Nature of Activity/ies
Curricular
o Educational Tour (more than 1 day)
o Field Trip (lasting only 1 day)
o Field Study, Experiential Learning or
Related Learning Experience
Non-Curricular
o Mission-based activity/ies
(retreat, recollection, etc.)
o Conventions, seminars, conferences,
symposiums, trainings, and
teambuilding
o Volunteer work including peer helper
programs, relief operations, community
outreach and immersion
o Advocacy projects and campaigns
o Participation in sports activities
o Activities initiated by recognized various
student groups
o Interschool competitions/tournaments
o Culture and arts performances and
competition
If Curricular Activity/ies
1. Curriculum Requirement
(Attach course syllabus which reflects the
relevance of requiring an educational tour and
field trip.)
Common Requirements
1. Destination
(Proof that the destination and schedule are
relevant to the subject matter.)
2. Handbook or Manual
(This should include the requirements and
guidelines of the conduct of local off-
campus activity/ies.)
3. Student’s Consent
of Parents/Guardians
(Aside from the parental consent template
issued by the Office of Student Affairs, this
document should include the title, venue,
date and detailed schedule of the
activity/ies, travel itinerary, breakdown of
the amount to be collected from the
students, mode of transportation to be
used, accommodation (if staying overnight),
curfew hours and general “house” rules)
4. Medical Clearance of Student
(This must be secured by the student
before engaging in any preparations or
taking any actions regarding the activity/ies.
This must be signed by the University or
Government Physician.)
5. Personnel-in-Charge
University Memorandum designating
the employee as Personnel-in-Charge
of the activity/ies with detailed tasks,
duties and responsibilities before,
during and after the off-campus
activities.)
Relevant certificate on first-aid training
6. First Aid Kit
7. Fees/Fund Source
Duly approved schedule of fees
(detailed breakdown of fees to be
collected from the students)
Certificate of Availability of Funds (if
charged against University fund or
custodial fund)
8. Insurance
Insurance as covered by the University
Student Insurance
Passenger Personal Accident
Insurance for Public Utility Vehicles, if
opted to seek third party services.)
9. Mobility of Students (Choose from the list
below)
Owned by the University
o University Memorandum issued for
the purpose
o Duly Approved Trip Ticket
o Detailed Travel Itinerary
Public Transportation
o University Memorandum issued for
the purpose
o Duly Approved Travel Order
o Detailed Travel Itinerary