Division of Quezon City Schools

Quezon City 6th District , Metro Manila

Placido Del Mundo Elementary School
School District XX

_____________________
Date
The Schools Division Superintendent
Quezon City, Metro Manila

Sir / Madam :
I have the honor to request permission to pursue my studies leading to the degree of
__________________________________________________________________ at the
_________________________________________________________________ starting
________________ Semester / Summer______________________________________
Enclosed herewith is a list of the subjects I intend to take as approved by the
registrar.
In this connection , I am submitting herewith some additional information.
Educational Attainment ___________________________________________
Year/s in College ________________________________________________
Total units earned ________ Major ___________ Minor ______________
Teaching Experience in this Division ______________________________
Latest Performance Rating _______________________________________
I hereby certify that I am thoroughly acquainted with the regulations under BPS
Circular No. 17 s.1960 amended by Circular No. 3, s. 1972 and further amended by
Circular No. 7 , s. 1973 and will comply with all the rules and regulations contained
therein.
Very truly yours,
____________________
Signature of Applicant
RECOMMENDING APPROVAL
__________________
______________________________ Printed Name of Applicant
Principal IV
( Print Name Below Signature)
 ( Inclosures to the Letter of Application for Permit to Study)
College / University : ________________________________________________
Subjects Credit Rating School 1st / 2nd With or
Already taken Year summer Without
permit

Subjects to be taken Credit

Subject still to be taken Credits Subjects still to be taken Credits

CERTIFIED CORRECT

______________________________
Dean / Registrar
( Print Name below Signature)

NOTE :
This request should be in the Division Office at least two ( 2 ) months before the
enrolment period . The regular study load of a teacher is not more that 9 units during
college term for BSE and 6 units for MA during semestral term and 9 units during
summer term.