Republic of the Philippines

Department of Education
Quality Assurance Division

APPLICATION FORM FOR THE OPENING/ADDITIONAL OFFERING OF SHS PROGRAM (PRIVATE SCHOOL)

Region/Division : X School Name: Iligan Computer Institute Inc. - Kapatagan

Contact Person: Dinna Lou J. Piedad Address: P13, Poblacion, Kapatagan, Lanao del Norte
Designation: School Head Contact No.: 0917-322-4135
Date of Application: November 16, 2022 SY of Intended Operation: 2023 - 2024

REQUIREMENTS
REMARKS/FINDINGS
ITEM √ or X
Document Evaluation Ocular Inspection
A. REQUIRED DOCUMENTS
Letter of Intent
Indorsement from Division Office
A. Board Resolution Certified by the Secretary and Approved by the Board of Directors/Board of Trustees
a. Purpose
b. School Year of Intended Operation
c. SHS Curriculum for the Track/s and Strand/s to be offered
 Republic of the Philippines
Department of Education
Quality Assurance Division
B. Certificate of Recognition of any of the following:
a. Secondary Education Program -DepEd
b. Training Program – TESDA
c. Higher Education Program – CHED
d. Others:
 FAAP recognized accrediting agencies
 Asia Pacific Accreditation and Certification Commission (APACC)
C. Proposed Tuition and Other School Fees
D. Proposed School Calendar
E. Proposed List of Academic and Non-Academic Personnel
a. Qualifications

b. Job Descriptions

c. Teaching Load

d. Number of Working Hours per Week

 Republic of the Philippines
Department of Education
Quality Assurance Division

REMARKS/FINDINGS
ITEM √ or X
Document Evaluation Ocular Inspection
e. Certification from Recognized National/International Agencies (TESDA, ABA, and
others)

F. CURRICULUM OFFERING

Academic track Strand: _________________________________________________________________________________________________

Tech-Voc Track Strand: HE : __________________________________________________________________________
ICT : __________________________________________________________________
IA : __________________________________________________________________
AFA : __________________________________________________________________
Arts and Design Track Strand: Performing Arts: ___________________________________________________________________________
Arts Production : __________________________________________________________________________
Sports Track
Unique Track

G. MINIMUM PROGRAM REQUIREMENTS FOR THE SHS TRACKS / STRANDS

1. Instructional Rooms
2. Laboratories
2.1 Computer
 Republic of the Philippines
Department of Education
Quality Assurance Division
2.2 Science (for STEM minimum of 3 Laboratory)
2.3 Workshop Room/Studios
3. Athletic Facilities
4. Learners’ Resource Center or Library
5. Internet Facilities
6. Ancillary Services
A copy of Memorandum/Memoranda of Agreement/Memorandum of Understanding for Partnership Arrangements relative to the SHS Program Implementations.
These arrangements may include:
a. Engagement of Stakeholders in the Localization of the Curriculum

b. Work Immersion
c. Apprenticeship
d. Research
e. Provision of Equipment and laboratories, workshops, and other facilities.
f. Organization of Career guidance and youth formation activities
g. Others

Additional Requirements for Category D:

a. Articles of Incorporation and by-laws for private schools only
b. Documents ownership of school sites under the name of the school, or deed of usufruct
c. Proposed annual budget and annual expenditures

Reviewed By: Complete

______________________________ Incomplete REMARKS: ______________________________________________
SDO/RO Validator ______________________________________________
Date: _________________________
 Republic of the Philippines
Department of Education
Quality Assurance Division

Remarks:

Recommended for Ocular Inspection Tracks/Strands/Specializations:

_______________________________________________
_______________________________________________
With Deficiencies: _________________________________________________________________________

Date of Ocular Inspection: _________________

Recommendation Action:
______ Recommended for Approval (Indicate track/strand and specializations for Tech-Voc Track)
(Specify): ________________________________________________________________________________________
________________________________________________________________________________________

______ Deferment: ____________________________________________________________________________________

____________________________________________________________________________________
____________________________________________________________________________________
 Republic of the Philippines
Department of Education
Quality Assurance Division

For Revalidation on: _____________________________

________________________________ _____________________________
SDO/RO Validator SDO/RO Validator
(Signature over Printed Name) (Signature over Printed Name)

Revalidated on: __________________________

REMARKS:

Recommended for Issuance of Government Permit (Indicate track/strand and specializations for Tech-Voc track)
(Specify): ______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________

Recommended for Deferment:

______________________________________________________________________________________________
 Republic of the Philippines
Department of Education
Quality Assurance Division
______________________________________________________________________________________________

______________________________ ______________________________
SDO/RO Validator SDO/RO Validator
(Signature over Printed Name) (Signature over Printed Name)

Date of Review: __________________________

Action Taken:
_______ For Approved Permit (Indicate track/strand and specializations for Tech-Voc Track)
_____________________________________________________________________________________________
_______ Recommend to applicant to defer operation upon completion of K to 12 SHS Program requirements
_______ Others (please specify): _______________________________________________________________________
_______________________________________________________________________

Noted By: Approved By:

OSCAR P. FLORES ____________________

Chief Education Supervisor Regional Director
Quality Assurance Division