University of Negros Occidental-Recoletos

51 Lizares Avenue, Bacolod City, Negros Occidental

Office of the Director of Student Affairs

Student Organization Activity Form for Online Activities

ORGANIZATION: ___________________________________________________________________

CP Number: _____________________________ Budget: __________________________

ACTIVITY TITLE: __________________________________________________________________

Date: _________________________ Day:______________

Time : _________________________________________________________

Media Platform to be used: _________________________________________________________

Details / Notable Information ( if any)

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

Learning Outcomes: At the end of the activity, the students will be able to:

1. ____________________________________________________________________

2. ____________________________________________________________________

3. ____________________________________________________________________

Target Core Value/s: __________________________

Prepared by: ____________________________________________________

SSG President/ Governor/Organization President/ Person in Charge

(the DSA shall consider the signature of the above provided that verbal approval from other student leaders, as needed, has
been secured)

Recommended by: ___________________________________

Adviser’s Signature

If not possible to acquire the adviser’s signature, please attach here an evidence of the adviser’s approval
like screenshots of the conversation in fb, email, text, etc.
 ___________________________________
COF Adviser/Dean/University Chaplain

If not possible to acquire the COF Adviser/Dean/University Chaplain’s signature, please attach here an
evidence of the adviser’s approval like screenshots of the conversation in fb, email, text, etc.

After compliance with the above requirements, send this form in word format at dexterpauldioso@uno-r.edu.ph

Approved by:

__________________________________
Dexter Paul D. Dioso, PhD, CSASS
Director of Student Affairs

The office of student affairs shall attach here a certification of approval and other items to be complied when
needed.

Other items to be complied before the conduct of the activity.

Wait for the DSA to send back this file to your email. Thank you and God bless. Stay safe.