DON MARIANO MARCOS MEMORIAL STATE UNIVERSITY

MID LA UNION CAMPUS

City of San Fernando, La Union
Telefax: (072) 700-5453
www.dmmmsu.edu.ph
STUDENT AFFAIRS AND SERVICES

SAS-SO-FORM 1
REGISTRATION/RENEWAL OF STUDENT ORGANIZATION

I. BASIC INFORMATION ◻ New ◻ Renewal

Name of Organization: Student Crime and Accident Prevention Council

Type of Organization Student Organization Number of Years Recognized: 3 years Date of 1st Recognition: year
2017 President: Samantha C. Bernardo Faculty Adviser/s: Reymar G. Malicsi
Contact No.: Email Address of the Organization: icje.scapc@gmail.com

II. OBJECTIVES:
1. Recommend to the school/ college/ university the conduct of seminars or trainings on crime and drug prevention and control in
coordination with the NAPOLCOM regional office, local police station or PDEA regional office;
2. Formulate crime prevention programs for the implementation of the organization;
3. Coordinate with the Chancellor, Chairperson or Dean, as the case maybe, in the maintenance of peace and order within the school
campus;
4. Conduct intensive information drive on crime prevention, particularly on drug abuse, alcoholism, illegal gambling, fraternity
quarrels, hazing accident prevention and other crime related activities;
5. Report illegal activities of students and/or recommend imposition of appropriate sanction/s by the school authorities, which shall
include but not limited to a reprimand, transfer, suspension or exclusion/expulsion from the school as prescribed in the Student Code of
Discipline.

OUTSTANDING ACTIVITIES PERFORMED (Preceding Year) (for renewing organization)

Date Title of Activity Place Remarks
1. Nov. 27, 2019 Cyber Crime Awareness – Empowering the DMMMSU-MLUC
Community through Media Ethics and Literacy. Covered Court
2.
3.
4.
5.

IV. MAJOR PROJECT/ACTIVITIES THIS SCHOOL YEAR

Date Title of Activity Place Remarks
1. November 2020 Traffic and Accident Prevention Seminar Via Webinar
2. December 2020 Online Contest Via Facebook /
YouTube Live
3. February 2021 Cybercrime Awareness Via Webinar
4. March 2021 VAWC Awareness Via Webinar
5. May 2021 Mental Health Awareness Via Webinar

I, Samantha C. Bernardo, hereby certify that all information herein stated are true and correct to the best of my
knowledge and belief and in behalf of my organization. I pledge to carry out the projected activities this school year.
Furthermore, my organization pledges to uphold the University Code of Discipline and comply with the CHED
Memo No.9 s2013.

October 13, 2020 SAMANTHA C. BERNARDO REYMAR G. MALICSI

Date Signed President Adviser

RECOMMENDING APPROVAL:

MA. CONCEPCION C. FERRAREN, MPA BERNARDO D. LAMADRID, Ph.D.

Adviser, Campus Student Body Organization Head, SAS

APPROVED:

EDUARDO C. CORPUZ, Ph.D.

Chancellor
INCLOSURES:
1. Constitution and By Laws of the Student Organization 5. SAS-SO-Form 5 Pledge of Commitment of Advisers and Officers
2. SAS-SO-Form 2 List of Officers and Members of the Student Organization 6. SAS-SO-Form 6 Declaration of Officers of Non-Violation of the Student Code of Discipline
3. SAS-SO-Form 3 Financial Statement of the Student Organization 7. SAS-SO-Form 7 Operational Plan
Services: Guidance and Counseling | Scholarship and Financial Assistantship | Housing | Testing and Test Materials | Student Body Organization | Student
Publication | Career and Placement | Student Spiritual Development | Peer Facilitators | Student Discipline |
Email Address: sas.mluc@dmmmsu.edu.ph
 DON MARIANO MARCOS MEMORIAL STATE UNIVERSITY
MID LA UNION CAMPUS
City of San Fernando, La Union
Telefax: (072) 700-5453
www.dmmmsu.edu.ph
STUDENT AFFAIRS AND SERVICES
4. SAS-SO-Form 4 Recommendation of the College Advisory Council 8. SAS-SO-Form 8 Accomplishment Report for Renewal of Student Organization

Services: Guidance and Counseling | Scholarship and Financial Assistantship | Housing | Testing and Test Materials | Student Body Organization | Student
Publication | Career and Placement | Student Spiritual Development | Peer Facilitators | Student Discipline |
Email Address: sas.mluc@dmmmsu.edu.ph
 DON MARIANO MARCOS MEMORIAL STATE UNIVERSITY
MID LA UNION CAMPUS
City of San Fernando, La Union
Telefax: (072) 700-5453
www.dmmmsu.edu.ph
STUDENT AFFAIRS AND SERVICES

SAS-SO-FORM 2
LIST OF OFFICERS AND MEMBERS OF THE STUDENT ORGANIZATION
School Year: 2020 – 2021

Name of Student Organization: Student Crime and Accident Prevention Council

College/Institute: Institute of Criminal Justice Education Department: BS Criminology

A. Roster of Officers
Complete Name Course
Designation Present Address ID No. Signature
(Surname, First, MI) & Year
BERNARDO, Samantha C. President Catbangen, SFC, LU BS Criminology 171-0328-2
1
IV – A
JUANCITO, Juancito Jr., M. Vice-President Mangaan, Santol, LU BS Criminology 171-0277-2
2
IV – A
ROGERO, Justine Joy F. Secretary Biday, SFC, LU BS Criminology 181-1011-2
3
III – A
MAYOH, Jan Lhurd G. Treasurer Central West, Bauang LU BS Criminology 181-1161-2
4
III – B
MORADOS, Reoul Emmanuel V. Auditor Pagdalagan Norte, SFC LU BS Criminology 181-1145-2
5
III – B
GALLARDO, Joshua G. Business Manager Poblacion, Aringay, LU BS Criminology 181-1100-2
6
III – B
FONTALBAN, Cadence Mae C. PRO Tanqui Lipit, SFC, LU BS Criminology 191-1618-2
7
II – A
MUNAR, Amir M. P.O. 1 Poro, SFC, LU BS Criminology 191-0595-2
8
II – B
DE GUZMAN, Aeron R. P.O. 2 Paringao, Bauang, LU BS Criminology 191-1555-2
9
II – B
10

11

12

13

14

15

B. Summary of Membership
1st Year 2nd Year 3rd Year 4th Year 5th Year Total

101 106 91 19 -- 317

Note: Please attach a categorized list of members of the student organization.

Prepared by Attested by

JUSTINE JOY F. ROGERO SAMANTHA C. BERNARDO REYMAR G. MALICSI

Secretary President Adviser

Services: Guidance and Counseling | Scholarship and Financial Assistantship | Housing | Testing and Test Materials | Student Body Organization | Student
Publication | Career and Placement | Student Spiritual Development | Peer Facilitators | Student Discipline |
Email Address: sas.mluc@dmmmsu.edu.ph
 SAS-SO-FORM 3
FINANCIAL STATEMENT OF THE STUDENT ORGANIZATION
For School Year: 2019 – 2020

Name of Student Organization: Student Crime and Accident Prevention Council

College/Institute: Institute of Criminal Justice Education Department: BS Criminology

A. COLLECTIONS
First Semester Second Semester
SOURCE Total
Amount Amount
1. Membership Fee Php 5,425.00 n/a Php 5,425.00

2. Annual Dues n/a n/a n/a

n/a n/a n/a

3. Other Sources:
n/a
Total Php 5,425.00 Php 5,425.00

B. EXPENSES

ACTIVITY EXPENSES

SEMINAR: Cyber Crime Awareness Program - ₱ 2,074.00

Empowering the Community through Media Ethics and Literacy
DMMMSU Founding Anniversary ₱ 1,782.50

Supplies of S.O. ₱ 259.00

TOTAL EXPENSES: ₱hp 4,115.50

C. CASH – ON – HAND: ₱hp 1,309.00

D. OUTSTANDING BALANCE: as of , 2019.

Note: Use another sheet of paper if necessary

Prepared by:

LERRY C. POBLETIN
Treasurer

Attested: Noted:

SAMANTHA C. BERNARDO REYMAR G. MALICSI

President Adviser
 SAS-SO-FORM 4
RECOMMENDATION OF THE COLLEGE ADVISORY COUNCIL
For School Year: 2020-2021

The College Advisory Council of the Institute of Criminal Justice Education – BS Criminology
endorses for the accreditation of the student organization for School Year 2019-2020, with details and
remarks below:

Name of Student Organization : Student Crime and Accident Prevention Council

College/Institute : Institute of Criminal Justice Education
Department : BS Criminology

Remarks of the College Advisory Council

REYMAR G. MALICSI
Adviser, College SBO

AURORA R. LAROYA
Director, ICJE
 SAS-SO-FORM 5
PLEDGE OF COMMITMENT OF ADVISERS AND OFFICERS
School Year 2020 – 2021

I, Reymar G. Malicsi, a faculty member of the College/Institute of Institute of Criminal Justice Education – BS
Criminology hereby affirm my acceptance as the Adviser of Student Organization – Student Crime and Accident
Prevention Council, with all my capability to support and assist the student organization.

I pledge to provide professional and moral guidance to the officers and members and to encourage them
to be actively involved in all activities of the University.

REYMAR G. MALICSI
Adviser

October 13, 2020

Date
 SAS-SO-FORM 6
DECLARATION OF OFFICERS OF NON-VIOLATION OF THE STUDENT CODE OF DISCIPLINE
School Year 2020 – 2021

Name of Student Organization : Student Crime and Accident Prevention Council

College/Institute : Institute of Criminal Justice Education
Department : BS Criminology
Officers : BERNARDO, Samantha C. (President)
: JUANCITO, Freddie Jr., M. (Vice President)
: ROGERO, Justine Joy F. (Secretary)
: MAYOH, Jan Lhurd G. (Treasurer)
: MORADOS, Reoul Emmanuel V. (Auditor)
: GALLARDO, Joshua G. (Business Manager)
: FONTALBAN, Cadence Mae C. (PRO)
: MUNAR, Amir M. (P.O. 1)
: DE GUZMAN, Aeron R. (P.O. 2)

THIS IS TO CERTIFY that based on records, as students, the abovementioned officers are
considered of good moral character. They have not violated any provision in the student handbook, has
not committed any misdemeanor and was not subjected to disciplinary or administrative proceedings
for infractions of University regulations and policies.

THIS CERTIFICATION is issued upon the request of the above – named persons as a
requirement for their application to the accreditation of their student organization for School Year
2019- 2020.

ISSUED THIS 13th day of October 2020 at Don Mariano Marcos Memorial State University-Mid
La Union Campus, City of San Fernando, La Union.

Certified by

ANABELLE S. BUENDIA
Guidance Counselor

BERNARDO D. LAMADRID, Ph.D.

Head, Student Affairs and Services
 SAS-SO-FORM 7
OPERATIONAL PLAN
For School Year 2020 – 2021

Name of Student Organization : Student Crime and Accident Prevention Council

College/Institute : Institute of Criminal Justice Education
Department : BS Criminology

Project/Activity Objective/s of the Date of Persons Budgetary Source of

Activity Activity Involved Requirement Fund
Webinar - To acquire more information and November 2020
other related to traffic and Officers and members
accident prevention.
Online Contest To boost student’s confidence, December 2020 Members
and to showcase their talent in
social media platforms.
Webinar - To acquire more information and February 2021 Officers and members
other related to cyberspace
awareness.
Webinar - To acquire more information and March 2021 Officers and members
other related to violence against
women and their children.
Webinar - To acquire more information and May 2021 Officers and members
other related to mental health.

Prepared by Noted by

SAMANTHA C. BERNARDO REYMAR G. MALICSI

President Adviser
 SAS-SO-FORM 8
ACCOMPLISHMENT REPORT
FOR RENEWAL OF STUDENT ORGANIZATION
For School Year 2019 – 2020

Name of Student Organization : Student Crime and Accident Prevention Council

College/Institute : Institute of Criminal Justice Education
Department : BS Criminology

A. ACTIVITIES PERFORMED
Project/Activity Date of Activity Place of Activity Participants Income Remarks
Generated
(if any)
Cyber Crime Awareness
Program - November 27, 2019 DMMMSU – MLUC S.O. officers and
Empowering the Community Covered Court members. n/a
through Media Ethics and
Literacy
Note: Please attached relevant supporting documents and pictures for each activity. Use extra sheet of paper if
necessary.

Prepared by Noted by

SAMANTHA C. BERNARDO REYMAR G. MALICSI

President Adviser