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QA FORM 10
1`za
Republic of the Philippines
Department of Education
MIMAROPA Region
Meralco Ave. cor. St. Paul Road
Pasig City

REVISED PROCESSING SHEET

APPLICATION FOR MERGING OF SCHOOLS

Name of Schools (1) : ____________________________________

(2) : ____________________________________
School IDs : School1____________ School2__________
Proposed Name
of school : ____________________________________
Address of Schools : ____________________________________
Courses Offered : School 1 ___________ School2__________
School Year : ____________________________________
Date Received : ____________________________________
Date Evaluated : ____________________________________
Date Released : ____________________________________
Contact Persons : ____________________________________
Contact Numbers : ____________________________________
Email Address : ____________________________________

Particulars Quality Description Remarks

DO RO
Document  Submitted 2 sets of documents
Presentation (original and photocopies of the original documents)
 Submitted to RO within 1st week of
July of the current year
 Page finder descriptor tabs corresponding to the
numbers in the checklist were affixed accordingly
to each document
 Colored expanding folder per division
was utilized.
Calapan – Pink Occi.Mdo. - Red
Palawan – Yellow Or. Mdo - Orange
Marinduque – Green PPC - Blue
Romblon – Purple
Long Expanding folders and papers (8.5”x13”)
were used
All documents were listed in a Table of Contents
LIST OF DOCUMENTARY REQUIREMENTS AND ITS DESCRIPTION
1.Revised Duly accomplished and signed by the Division
Evaluation Review and Evaluation Committee
Sheet No information was left out by the processor
2. DepEd School Schools to be merged are listed in the EBEIS
IDs DepE Verified Correct
Name of d Yes No By Designatio Date
School School n
ID
1.
2.
3. Map Showed adjacent location of both schools (i.e.
they are contiguous, compact, or located directly
in front of the other or separated by a road)
Preferably drawn to scale, showing the distances
of the existing schools within the catchment area
of the proposed new school, duly certified by the
Municipal/City Engineer and validated by the
Schools Division Office

Revised 9.18.18
Quality Assurance Division Tel No. (02) 637-4184/Telefax (02) 637-3093 Email Address: qad.depedro4b@gmail.com
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QA FORM 10
Duly signed by the School heads

Name of Distance
Schools Within between the Address
the Catchment Schools to be
Area Merged (in
km)

4.Letter Request Addressed to the Schools Division Superintendent

(SDS) either from PTA or Barangay Council
Stated reasons for merging of the schools school
Duly signed by the requesting officer,
designation/position and date of request
5. Feasibility Study Contained the following:
 Justification on the need for the merging of
school
 Proposed Organizational Structure
 School Environment (Environmental
scanning/situational analysis) stating the
specified location/classification (Urban or
Rural), topography/geographical condition of
the site (Mountainous, Coastal, Plain),
catchment area as well as the mode of
transportation in going from home to school and
vice versa
 School map showing the location of the building
duly signed by the Division Engineer.
Proposed Budget/Budgetary Requirements
covering the 5-year proposed schools’ crucial
resources
Proposed School Development Plan duly
signed by the Division Engineer
Duly signed by the School Head and Punong
Barangay and countersigned by the SMME
6.School Covered five (5) years to include among others,
Implementation the following:
Plan Current and projected enrolment for five (5)
school years, by grade level;
GRADE CURRENT PROJECTED
LEVEL Sch1 Sch2 Tota Yr1 Yr2 Yr3 Yr4 Yr5
l


Proposed budgetary requirements for its
Personal Services, MOOE, and Capital Outlay;
Supported
Particulars Year Year Year Year Year w/
1 2 3 4 5 Breakdown?

Revised 9.18.18
Quality Assurance Division Tel No. (02) 637-4184/Telefax (02) 637-3093 Email Address: qad.depedro4b@gmail.com
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QA FORM 10
Yes No
Personal
Services
MOOE
Capital
Outlay
TOTAL

Duly signed Strategic Plan re: curriculum and

Instructional supervision of the proposed school
as merged; and
Duly signed School Site Development Plan
(SSDP) of the schools to be merged, including
the proposed school buildings, as needed
Duly signed Inventory of Learning Resources
(LRs) prepared by the property Custodian of
both schools to be merged
Particulars School 1 School 2
Inventory of LRs
prepared by
Position/Designation
Date

Updated PSIPOP of both schools to be merged

Particulars School 1 School 2
School Head
Items
No. Of
Teaching Items
No. Of Support
Staff
TOTAL

Updated Status Report of the schools to be

merged with regard to their existing crucial
resources
Status Report
Particulars School 1 School 2
Status Report
Prepared By
Position/Designation
Date

Resources Needed
Particulars Amount
Personal Services
MOOE
Capital Outlay
Total
7. Memorandum of Stated that School Heads concerned agree on
Agreement the merging of necessary teaching and non-
(MOA) teaching items as well as other crucial resources
of the merged schools
Drawn up by and between the SDS and School
Heads concerned indicating among others, the
crucial resources for the proposed merged
schools. (Refer to Annex E-3 for the sample MOA
template.)
Duly signed by and between the SDS and School
Heads concerned
Notarized

Revised 9.18.18
Quality Assurance Division Tel No. (02) 637-4184/Telefax (02) 637-3093 Email Address: qad.depedro4b@gmail.com
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QA FORM 10
8. Designation Duly signed Designation Order by the SDS for the
Order OIC/TIC of the merged schools
9. Sangguning Contained statement of support to the merging of
schools with certification, as the case maybe,
Bayan/Panglungsod where the LGU shall continue to provide funds for
Resolution the operation and maintenance of the merged
schools
Particulars Amount
a. Construction of new school PhP
building/classrooms
b. Procurement of educational
facilities, furniture,
textbooks
c. Operation and maintenance of the
merged schools
d. Salaries of teaching and non-
teaching personnel
e. Other LGU support
TOTAL PhP

Duly approved by the Municipal/City Mayor

Indicated the proposed name of the school
3. Division Template was completely filled out
Inspection COMPLIANT
Report PARTICULARS TO
STANDARD
YES NO
1.School Building/Classroom
2.No. of available classrooms, if
any
3. Size of school site in square
meters

Duly signed inspection report from In-Charge of

Education Facilities Section/SMME In-Charge of
Inspection
8.School Site Complied lot size requirement of at least 5,000
Document square meters or one half (1/2) hectare for rural
areas; 2,500 square meters for highly urbanized
cities
Conformed to any one of the following
requirements:
Deed of Donation
▪ Duly signed by the donor and done (SDS) and witnesses
▪ Duly accepted by the SDS as the done
▪ Notarized
Deed of Sale or Contract of Usufruct
▪ Duly signed by both contracting parties
▪ Land Title
▪ If tax declaration, attached certificate of no pending land
registration application from the Registry of Deeds
(ROD) or from the Regional Trial Court (RTC)
● Type of land indicated in the Tax Declaration
like Timberland must be converted into a
school site and Ancestral land in consultation
with the NCIP
▪ If public elementary to public secondary, contracting
parties are the school heads to be confirmed by the SDS.
Letter request to the CO through the RO for the Deed of
confirmation to be signed by the SDS
Duly signed justification by the SDS if
aforementioned criterion was not met

Revised 9.18.18
Quality Assurance Division Tel No. (02) 637-4184/Telefax (02) 637-3093 Email Address: qad.depedro4b@gmail.com
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QA FORM 10

Evaluated by the Division and Evaluation Committee (DREC):

SMME Div. Admin. Officer Div. Planning

Officer

___________________ ____________________ ___________________

Division Accountant In-Charge of Education Facilities SGOD Chief

Validated by the Regional Inspectorate Team (RIT):

____________________ _______________________ ___________________

ENGR. DIEGO BUSTAMANTE WENDELL I. FORMALEJO, PhD. MELBERT S. BROQUEZA, PhD.
In-Charge, Education Facilities EPS, CLMD EPS, QAD

_______________________ ________________________ ____ __________________

RITCHIE G. DIOLA, PhD. ARDEE DC RAMILO ATTY. RENEE R. MORENO-PEREZ
EPS, QAD CAO, Finance Atty. IV, Legal Unit

__________________________
GLORIA M. CRUZ
Chief, QAD

__________________________
RUTH L. FUENTES, CESO V
OIC, Office of the Assistant Regional Director

Revised 9.18.18
Quality Assurance Division Tel No. (02) 637-4184/Telefax (02) 637-3093 Email Address: qad.depedro4b@gmail.com