Republic of the Philippines

Department of Education
Regional Office I
Quality Assurance Division

APPLICATION FORM FOR GOVERNMENT

RECOGNITION TO OPERATE PRIVATE SCHOOL
____________________________
Course(s)

Name of School :
Address :
Date of Application :

REQUIREMENTS
___ 1. Updated Board Resolution certified and signed by the Corporate Secretary

___ 2. Articles of Incorporation duly registered with the SEC

___ 3. Documents of ownership/Transfer Certificate of Title of:

___ 3.1 school site/additional site;
___ 3.2 school building/additional school building;

___ 4. Updated certificate of occupancy issued by the city/municipal engineer

___ 5. Proposed budget for the succeeding school year duly approved by the Board
of Trustees/Directors

___ 6. Copy of latest Financial Statement of the school certified by an independent

Certified Public Accountant

___ 7. Certified photocopy of receipt of up-to-date payment of:

___ 7.1 Retirement premiums
___ 7.2 Pag-IBIG
___ 7.3 PhilHealth
___ 7.4 Other insurance benefits
___ 7.5 etc. (please specify) ______________________________

___ 8. List of basic Science laboratory equipment/instruments/facilities

CHEMISTRY EQUIPMENT
8.1 Science lab table (constructed either at the center 8.2 Ball value set for water line
or at the side wall of the room) _____sink(s)/lavatory
8.3 Ball value set gas line _____ Bunsen burner 8.4 Cork Borer

8.5 Iron clamp 8.6 Tripod set

DepEd Region 1: Built on character; empowered by competence.

Address: Flores St., Catbangen, City of San Fernando, La Union

Telephone Number: (072) 607-8137 / 682-2324; Email Address: region1@deped.gov.ph
 Republic of the Philippines
Department of Education
Regional Office I
Quality Assurance Division

8.7 Erlenmeyer flask set 8.8 Beaker glass flask set

8.9 Rubber stopper 8.10 Laboratory thermometer

8.11 Mortar & pestle 8.12 Class funnel set

8.13 Litmus paper (red & blue) 8.14 Ph paper

8.15 Test tubes & test tube racks 8.16 Stirring rod set

8.17 Spatula set 8.18 Watch glass set

8.19 Dropper glass long tip 8.20 Filter paper

8.21 Test tube holder set 8.22 Glass tubing assorted sizes

8.23 Magnifying lens 8.24 Microscope(s)

8.25 Graduated cylinder 8.26 Wire gauze

8.27 Alcohol lamp 8.28 Shower room

8.29 Storage for consumables 8.30 Storage for equipment

___ 9. List of basic Biology laboratory equipment/instruments/facilities

BIOLOGY EQUIPMENT/INSTRUMENTS
9.1 Human torso model bisexual/picture 9.2 Circulatory system model/picture

9.3 Digestive system model/picture 9.4 Reproductive system model/picture

9.5 Respiratory system model/picture 9.6 Organ of endocrine system model/picture

9.7 Skin block model/picture 9.8 Urinary system model/picture

9.9 Ear anatomy 9.10 Eye model

9.11 Female reproductive system 9.12 Liver model/picture

9.13 Brain model/picture 9.14 Kidney model/picture

9.15 Human heart model/picture 9.16 Human embryology/picture

9.17 Dissecting set 9.18 Glass slides

9.19 Specimen bottles 9.20 Microscope

9.21 Cover glass fs 9.22 Crucible tongs

9.23 Crucible with cover 9.24 Reagent bottles amber

9.25 Aluminum tray 9.26 Inoculating loop

9.27 Inoculating needle 9.28 Pipette

9.29 Petridis 9.30 Evaporating dish

9.31 Wash bottle 9.32 Bell jar

___ 10. List of basic Physics laboratory equipment/instruments/facilities

DepEd Region 1: Built on character; empowered by competence.

Address: Flores St., Catbangen, City of San Fernando, La Union

Telephone Number: (072) 607-8137 / 682-2324; Email Address: region1@deped.gov.ph
 Republic of the Philippines
Department of Education
Regional Office I
Quality Assurance Division

PHYSICS EQUIPMENT/INSTRUMENTS
10.1 Alligator clips 10.2 Aluminum cylinder with hook

10.3 Ammeter 10.4 Anemometer

10.5 Air core solenoid 10.6 Balance platform

10.7 Barometer mercurial 10.8 Block brass 1”

___ 10.8.1 block brass ½”

___ 10.8.2 block brass ¾”

10.9 Calorimeter 10.10 Inclined plane

10.11 Uniform solid disk 10.12 Hooke’s Law apparatus

10.13 Heat transfer apparatus 10.14 Hydrometer light

10.15 Hydrometer heavy 10.16 Voltmeter

10.17 Pycnometer 10.18 Pycnometer

10.19 Compass 10.20 Battery assembly kit

10.21 Battery charger 10.22 Convex lens

10.23 Prism 10.24 Electricity kit

10.25 Electroplating & balance kit 10.26 Force measurer kit

10.27 Marble 10.28 Pendulum bob

10.29 Meter stick 10.30 Pulley

10.31 Quartz apparatus 10.32 Spring balance

10.33 Scientific calculator 10.34 Tuning fork

___ 11. List of basic consumables/chemical substances

11.1 Filter paper 11.2 Barium chloride

11.3 Calcium chloride 11.4 Calcium hydroxide

11.5 Calcium oxide 11.6 Copper sulfate

11.7 Cornstarch 11.8 Sodium carbonate

11.9 Sodium bicarbonate 11.10 Sodium dichromate

11.11 Sodium nitrate 11.12 Sodium sulfate

11.13 Sodium thiosulfate 11.14 Sulfur powder

11.15 Sulfur nitrate 11.16 Starch

11.17 Distilled water 11.18 Yeast

11.19 Naphthalene 11.20 Calcium carbide

DepEd Region 1: Built on character; empowered by competence.

Address: Flores St., Catbangen, City of San Fernando, La Union

Telephone Number: (072) 607-8137 / 682-2324; Email Address: region1@deped.gov.ph
 Republic of the Philippines
Department of Education
Regional Office I
Quality Assurance Division

11.21 Denatured alcohol

LIBRARY FURNITURE & EQUIPMENT

(For School Library – DepEd Order No. 56, s. 2011)
___ 12. Library furniture
___ 12.1 Reading tables (number that accommodate 15.25% of the enrolment)
Specifications
 Elementary – 0.71m (h) x 0.91m (w) x 0.91m (l)
 Secondary – 0.91m (h) x 0.90m (w) x 1.80 m (l)
___ 12.2 Armless chairs (same as above)
Specifications
37cm (w), 43.50cm (d), height of backrest: 43cm
Total height: 89cm
___ 12.3 Librarian’s table
Specifications
1.22m (w) x 0.66m(l) x 0.76m(h)
___ 12.4 Librarian’s chair
47cm (w), 43.5cm (d), height of back rest-43cm
Total height: 89cm
___12.5 Charging desk/circulation (depending on the design)
Simple and functional in design with space provided for filing trays for book
cards and shelved for returned books. It should also be designed with
provision for computers for circulation. The desk may be count height or
sitting height.

___ 12.6 Card catalogue with trays (will depend on the collection). With handle
label holder and rod with 36 trays
0.90m (w), 1.18m(h), 0.45m(d)
___ 12.7 Periodical index cabinet (same as card catalogue cabinet)
___ 12.8 Shelf list card cabinet (same as the card catalogue cabinet with
12/24/36 trays)
___ 12.9 Book shelves: preferably adjustable single faced/double faced/wall
shelves
Specifications
 30m (d) x 1.3m(w) x 0.76-1.5m(h)
 Height of shelves:
Elem: not more than 1.5m
HS: not more than 1.8m
 The bottom shelf should slope back to facilitate reading call
___ 12.10 Vertical file cabinet (depending on the number of clippings folders).
Standard filing cabinet.
___ 12.11 Magazine rack (depending on subscription titles)
___ with ten shelves: 0.30m(d) x 0.40m(w) x 1.52m(h)
___ or size and design vary
___ 12.12 Newspaper display rack (depending on the number of subscription
DepEd Region 1: Built on character; empowered by competence.

Address: Flores St., Catbangen, City of San Fernando, La Union

Telephone Number: (072) 607-8137 / 682-2324; Email Address: region1@deped.gov.ph
 Republic of the Philippines
Department of Education
Regional Office I
Quality Assurance Division

titles
___ 10 rungs of 0.30 x 0.40 m in size
___ or size and design vary
___ 12.13 Dictionary stand and atlas stand/shelves (minimum of 3). Slop top
with 3 shelves
___ 12.14 Storage cabinet
0.40m(d) x 0.90m(w) x 1.83m(h)
___ 12.15 Furniture for informal reading, sofa set and bean bags
___ 12.16 Bulletin board (at least 2 or depending on the available space)
o Cork or magnetic 2.40 (l) x 1.20m (w)
___ 12.17 Step stool (minimum of 4), different sizes/heights
___ 12.18 Book truck, 2 or 3, with shelves and ball caster
___ 12.19 Large picture files (depending on the number of collection, size and
design)
___ 12.20 Computer (aside from those installed in the computer laboratory)
___ 1 for 1,000 enrolment
___ for clerical work, for circulation desk, for OPAC terminals
___ work stations where students and teachers can use software
packages, word-process work, CD-ROM and internet

___ 13. Collection Management

___ 13.1 A basic collection of 3,000 book titles for the elementary level and
5,000 titles for the secondary level is necessary to support the
curricular offerings of the school
___ 13.2 Twenty percent (20%) of the total collection shall be published
within the last ten (10) years
___ 13.3 A basic subscription to 3 titles of general interest magazines and 10
titles of professional journals
___ 13.4 A basic subscription to 3 titles of newspapers on national coverage
and 1 title with local news coverage
___ 13.5 An updated collection of pamphlets, clippings, government
documents, vocational information and other materials appropriate to
the curriculum and interest of students are provided
___ 13.6 A starting collection of non-print materials on various formats as
follows:
___ 13.6.1 one (1) map for each geographic region and 1 special map
(i.e. economic, weather, political, historical, etc.) for each type
being studied. The number of duplicates will be determined by
the number of sections that will be using the map at the same
time.
___ 13.6.2 two (2) globes
___ 13.6.3 100 titles of video recordings on different subject areas
___ 13.6.4 200 titles of sound recordings on different types of music
___ 13.6.5 15 titles of slide sets
___ 13.6.6 25 titles of transparency sets
___ 13.6.7 50 titles of electronic resources (e.g. CD-ROMS, audio
books, etc.)

DepEd Region 1: Built on character; empowered by competence.

Address: Flores St., Catbangen, City of San Fernando, La Union

Telephone Number: (072) 607-8137 / 682-2324; Email Address: region1@deped.gov.ph
 Republic of the Philippines
Department of Education
Regional Office I
Quality Assurance Division

___ 13.6.8 An acquisition of 1,000 places representing pictures,

charts, study prints, photographs and other types of graphic
materials
___ 14. Selection, Organization, Preservation & Security, Services & Utilization
___ 14.1 Book selection shall be a shared responsibility among the
librarians, teachers and administrators
___ 14.2 All print and non-print materials and equipment shall be properly
organized, stored, and displayed following standard rules and
procedures of cataloging and classification for easy retrieval and
dissemination
___ 14.3 An inventory and weeding of the collection shall be conducted
regularly
___ 14.4 The school library media center shall have a program for the care
and preservation of all its collection. It should also have an adequate
safeguard against loss, mutilation, and theft.
___ 14.5 The school library media center shall be open before, during and
after classes to meet the needs of the clientele and maximize the use
of library resources, facilities and services
___ 15. TLE laboratory facilities/equipment (Home Economics, Agriculture,
Industrial Arts
___ 15.1 Home Economics laboratory
15.1.1 Dining set/dining area 15.1.2 Kitchen

15.1.3 Kitchen wares/utensils 15.1.4 Bedroom, bed, bedding, mirror/tocador

15.1.5 Sala, sala set 15.1.6 Comfort room

___ 15.2 Agriculture lot/equipment/tools

15.2.1 space for garden plots 15.2.2 nursery

15.2.3 wheelbarrow 15.2.4 rake(s)

15.2.5 shovel(s) 15.2.6 garden tools

15.2.7 plant sprinkles

___ 15.3 Industrial Arts shop/equipment/tools

15.3.1 Industrial Arts shop 15.3.2 working table(s)

15.3.3 carpentry tools 15.3.4 bench grinder

15.3.5 press drill for wood & metal

___ 16. Sports & Athletic facilities/equipment

16.1 space/lot for sports/athletics 16.2 table tennis/set of tennis racket

16.3 set of badminton 16.4 set of volleyball

16.5 set of basketball 16.6 chessboard

16.7 timer(s) & whistle(s) 16.8 seesaw (for Pre-Elem & Elem)

DepEd Region 1: Built on character; empowered by competence.

Address: Flores St., Catbangen, City of San Fernando, La Union

Telephone Number: (072) 607-8137 / 682-2324; Email Address: region1@deped.gov.ph
 Republic of the Philippines
Department of Education
Regional Office I
Quality Assurance Division

16.9 swing & slide 16.10 discuss throw

16.11 shot-put 16.12 sepak takraw

COMMENT(S):

RECOMMENDATION(S):

Reviewed by:

______________________________
Education Program Supervisor
Quality Assurance Division

REMARKS:

All requirements complied with

With deficiencies (marked x)

Noted: Date: _______________

ACTION:
OSCAR P. FLORES
Chief Education Supervisor Conduct ocular/on-site
Quality Assurance Division inspection/validation
Notify Division EPS In-charge

DepEd Region 1: Built on character; empowered by competence.

Address: Flores St., Catbangen, City of San Fernando, La Union

Telephone Number: (072) 607-8137 / 682-2324; Email Address: region1@deped.gov.ph
 Republic of the Philippines
Department of Education
Regional Office I
Quality Assurance Division

of Private Schools Task Force of

Deficiencies
__ phone
__ e-mail
__ indorsement

Prepared by:

Education Program Supervisor

Quality Assurance Division

Documents Received by:

__________________________________ __________

Document Code: RO1-LQF-QAD-009

Revision: 01
Effectivity Date: 10-07-2019

DepEd Region 1: Built on character; empowered by competence.

Address: Flores St., Catbangen, City of San Fernando, La Union

Telephone Number: (072) 607-8137 / 682-2324; Email Address: region1@deped.gov.ph