Division Memorandum No. 106 s. 2022 - Various Forms for Application of Private Schools Government Permit Recognition, Reissuance of Recognition, Homeschooling Program, and Increase of Tuition and Other School (1)

June 29, 2022
DIVISION MEMORANDUM
NO. ________,
106 S. 2022
VARIOUS FORMS FOR APPLICATION OF PRIVATE SCHOOLS

GOVERNMENT PERMIT/RECOGNITION, REISSUANCE OF RECOGNITION,
HOMESCHOOLING PROGRAM, AND INCREASE IN TUITION & OTHER SCHOOL FEES
FOR SCHOOL YEAR 2023-2024
TO: Acting Assistant Schools Division Superintendent

Chief Education Supervisors, SGOD and CID
Private School Administrators
Other Concerned Personnel
1. In line with the application of Private Schools for Government Permit, Recognition,
Reissuance of Recognition, Homeschooling Program, and Increase in Tuition and Other
School Fees for School Year (S.Y.) 2023-2024, attached are various forms that will be used
and will serve as checklist of requirements for validating the submitted documents.
2. Documentary requirements must be submitted in hard copy with proper earmark.

Soft copies must be scanned and labeled properly per item following the checklist
indicated in the form and submit via google drive: https://tinyurl.com/SDOMar-Private-
SY2023-2024 or email: sgod.marikina@deped.gov.ph.
3. Letter of intent shall be addressed to the Regional Director thru the Schools
Division Superintendent. Please note that only applications with complete documents
shall be processed.
4. Be guided with the deadlines stipulated in DepEd Order No. 88, s. 2010. To
provide the Schools Division Office enough time to validate and check completeness of the
required documents prior to submission to the Regional Office, all concerned are hereby
enjoined to follow the schedule below:
Regional Office SDO Marikina Applicable Form

Application Type
Deadline Deadline (to be used)
New Permit / August 30th July 15th SDOMar-Form1-
Additional level / preceding the start preceding the GPR-2022
Additional track-strand of the S.Y. start of the S.Y.
October 25th SDOMar-Form2-
January 2nd
preceding the GPR-2022
Renewal of Permit preceding the
opening of the
opening of the S.Y.
S.Y.
On or before On or before SDOMar-Form3-
Recognition/
February 1st, December 1st GPR-2022
Re-issuance of preceding the preceding the SDOMar-Form4-
Recognition opening of the S.Y. opening of the GPR-2022
Address: 191 Shoe Avenue, Sta. Elena, Marikina City

Telephone No: +63 02 8742-3122 • 8682-3989 • 8742-4377
Email: sdo.marikina@deped.gov.ph
Website: https://www.depedmarikina.ph
S.Y.
October 25th SDOMar-Form5A-
January 2nd
Home Schooling preceding the HSP-2022
preceding the
Program opening of the
opening of the S.Y.
S.Y.
March 15th SDOMar-Form7-
Tuition and Other May 15th
preceding the TOSF-2022
School Fees preceding the
opening of the
Increase/Decrease opening of the S.Y.
S.Y.
5. Immediate and wide dissemination of this Memorandum is desired.
SHERYLL T. GAYOLA
Schools Division Superintendent
SGOD/SMM&E
Date Prepared: 29/06/22

Telephone No: +63 02 8742-3122 • 8682-3989 • 8742-4377
Republic of the Philippines
Department of Education SDOMar-Form1-GPR-2022
NATIONAL CAPITAL REGION (Ref: DepEd NCR Forms)
SCHOOLS DIVISION OFFICE OF MARIKINA CITY
EVALUATION FORM FOR NEW GOVERNMENT PERMIT APPLICATION
Name of School
Old Site
School Location
New Site
School Head Contact Person:
Position Telephone No:
School Email
Course/s Applied Grade Level Offerings School Year

Kindergarten
Elementary
SPED
Junior High School
Date Uploaded: __________________
______ 1. Letter of Intent addressed to the Regional Director through the Schools Division
Superintendent.
_______________ Date of Application
______ 2. Certified true copy of latest SEC Certificate of Registration and Articles of
Incorporation.
Purposes: ( ) Kindergarten ( ) Elementary ( ) SpEd ( ) Junior High School
_____ Non-stock Educational Corporation ____ Stock Educ’l. Corporation

_____ Registration Certificate Number
_____ Date of Issuance of SEC Registration Certificate
_____ Term of Corporate Existence
_____ Number of Directors/ Trustees
_____ Amount of Subscribed Capital Stock/ Contribution (must be sufficient
enough to cater to all the needs of the school for at least one year)
______ 3. School Child Protection Policy (SCPP) with Anti-Bullying Policy pursuant to DepEd
Order No. 40, s. 2012 and DepEd Order No. 55 s. 2013 (The Schools Division Office
shall check the submitted SCPP pursuant to their mandate provided under DO 40,
s. 2012).

Telephone No: +63 02 8742-3122 • 8682-3989 • 8742-4377
______ 4. Notarized Feasibility Study, covering comprehensively the following factors,

supported with sufficient evidence:
____ Purpose and objectives of proposed school or course
____ Availability and adequacy of school site and building including documents of
ownership thereof, location plan, development plan, pictures, or architect’s
plan of building, if the same is still to be constructed
____ Itemized cost of the project covering the entire course in terms of site, site
development, school building and quarters, classroom equipment and
facilities, library, salaries of faculty, and staff and maintenance
____ Financial capacity of application, including resources to provide the
requirements for the entire course and to support its operation from year to
year without depending solely on students’ fees
____ Proposed faculty lineup and administrative and supervisory staff together with
their individual Transcript of Records and evidence of willingness to join the
school
____ Need or demand for establishment of the school or operation of the course in
the locality. If the course is already being offered in the same town or city,
there must be an evidence of the following factors:
- Distance of the applicant school to the existing school
- Enrolment in the existing school/s
- Number of students and the same locality enrolled in schools other than in
the existing school
- Number of prospective students of application school
- Facilities, standards, and supportive provisions for effective instruction and
quality education
______ 5. School Site / Documents of Ownership

______ Certified True Copy/ies of Transfer Certificate of Title (TCT) No. ___________
______ Total lot area / Total floor area available (Indicated) __________
( ) Owned ( ) Donation ( ) Authority to use the school site
______ Location same as given address, if not, attached latest Certificate of Tax
Declaration which bears the same address
( ) in the name of the school
( ) in the name of the school owner / incorporator
( ) in the name of the congregation
( ) in the name of the lessor
_______ Contract of Lease for a period of at least 5 years with a definite feasible
plan for:
(1) the acquisition of its own school site within five (5) years from the date
of filing of the application for permit to operate (pursuant to DO 88 s. 2010)
and
(2) construction of school buildings/facilities on said school site within ten

(10) years from the said filing of the application for permit to operate
(pursuant to DO 11, s. 2011)

Telephone No: +63 02 8742-3122 • 8682-3989 • 8742-4377
Years of contract ______________

_______ Contract to Sell ( ) full payment ( ) with terms of payment in ____ years
_______ Usufruct
_______ Total No. of Instructional Rooms
_______ Classroom size in sq.m.
______ 6. Certified true copy of Occupancy Permit (Institutional/Educational)
______ 7. Inventory/List of Laboratory facilities, equipment, furniture, supplies and material

classified by subject area
______ 8. Inventory/List of Library Holdings classified per subject area or category
______ 9. Inventory/List of Athletic Facilities, Equipment, Supplies and Materials
______ 10. Pictures

______ School Building ______ Faculty Room
______ Flagpole ______ Registrar’s Office
______ School Grounds/Activity Area ______ Guidance Office
______ Playground ______ Principal’s Office
______ Classrooms ______ Medical & Dental Clinic
______ Computer/IT/Multimedia Room ______ Canteen
______ Library (Elementary and High School)
______ Restrooms (Separate for Boys and Girls)
______ Laboratories
______ Practice House/ EPP/ HELE
______ Industrial Arts Room / Working Area
______ Science (Gen. Science, Biology, Chemistry and Physics)
______ 11. Proposed Annual Budget for the School Year signed by the School Head
______ Annual Salaries
______ Maintenance Expenses
______ Capital Expenditures (Building, Property & Equipment)
______ 12. Proposed Tuition and Other School Fees for School Year signed by the
School Head
______ Tuition Fee ______ Miscellaneous Fees ______ Other Fees (if any)
______ 13. Latest Certificate of Bank Deposit in the name of the school indicative of
adequate funds to support operation for one year
______ 14. Proposed Curriculum

______ Implements the Enhanced Basic Education Curriculum (K-12)
______ Class Program for the course/s applied for

Telephone No: +63 02 8742-3122 • 8682-3989 • 8742-4377
_____ Kinder _____ Elementary _____ SpEd _____ Junior High School
______ Time Allotment per Grade Level & Subject Area

_____ correct ______ not correct
______ 15. List of Administrative Officials

____15.1 School Head or the President, Rector, Director or Chief Executive Officer
( ) Bachelors Degree or Masters Degree holder
( ) Filipino
( ) with adequate teaching experience, managerial competence and
technical expertise in school management or background of
demonstrated service in the previous field
( ) of good moral character
( ) full time
_____ Field of Specialization
_____ Certificates of Training
_____ Notarized copy of Employment Contract/ Appointment
_____ Certified true copy of Transcript of Records
_____ NBI Clearance/Police Clearance
_____ Teaching Load, if any
____ 15.2 Principal

_____ Master’s Degree in the Education and with at least five (5) years
Teaching experience
_____ PRC License
_____ Notarized copy of Employment Contract
_____ Copy of Certificates of Related Training (last 3 years)
____ 15.2.1 Salary Rate and benefits of Administrative Officials and

Principal
( ) within the minimum rate ( )above the minimum ( ) below the minimum
____ 15.3 List of Academic teaching Personnel (Presented in Tabular Form)

____ Kindergarten teachers are holders of Bachelor’s Degree in
Early Childhood Education or Bachelor’s Degree in Elementary
Education with at least 18 units of Early Childhood Education
____ Elementary school teachers are holders of a Bachelor’s Degree in
Elementary Education or its equivalent
____ Secondary school teachers are holders of a Bachelor’s Degree in
Secondary Education or its equivalent
_____ PRC license
_____ Teaching Loads
_____ Full time _____ Part Time
_____ Salaries (per hour/month) and benefits in accordance with

Telephone No: +63 02 8742-3122 • 8682-3989 • 8742-4377
prescribed standards in the Labor Code

( ) within the minimum rate ( ) above the minimum ( )below the minimum

_____15.4 List of Non-teaching Personnel (Registrar, Guidance Counselor,

Librarian, Administrative Staff, Nurse etc. presented in Tabular Form with
the following information: Name, Position, Educational Qualification,
Eligibility(if applicable), Employment Status & Salary)
____ Notarized copy of Employment Contract/Appointment

____ Certified true copy of Transcript of Records
____ Copy of Certificates of Related Training (last 3 years)
____ 15.4.1 Salary Rate and benefits of Non-Teaching Personnel

______ 16. Retirement Plan

_____ School initiated retirement plan registered with the BIR
_____ School Certificate of Registration
( ) SSS ( ) Philhealth ( ) Pag-ibig
______ 17. School Calendar

______ No. of School Days ______ No. of Holidays
______ 18. Student/ School Manual
______ 19. Application/Inspection Fee

_______________ Place of Issuance _________________ OR No.
_______________ Date of Issuance _________________ Amount
Date Evaluated: _______________
REMARKS: ( ) Complete
( ) SDO Accomplished Evaluation Form
( ) Indorsement signed by the Schools Division Superintendent
Date:__________________________
( ) Incomplete
( ) Date of Notice of Disapproval _________________

Telephone No: +63 02 8742-3122 • 8682-3989 • 8742-4377
COMMENTS/RECOMMENDATIONS:
_______________________________________________________________________________________
_______________________________________________________________________________________
_________________________________________________________________________________
Evaluated by: Noted:
_________________________ __________________________

Telephone No: +63 02 8742-3122 • 8682-3989 • 8742-4377
EVALUATION FORM FOR RENEWAL OF GOVERNMENT PERMIT APPLICATION
Name of School
Old Site
School Location
New Site
School Email
Course/s Applied Grade Level Years in School Year

Offerings Operation
Kindergarten
Elementary
SpED
Junior High School
Date Uploaded: __________________
_____1. Letter of Intent addressed to the Regional Director through the Schools Division
Superintendent
_____2. Certified true copy of latest SEC Certificate of Registration and Articles of
Incorporation
_____3. School Site / Documents of Ownership
______Certified True Copy/ies of Transfer Certificate of Title (TCT) No. ___________
______ Total lot area / Total floor area available (Indicated) ______________
( ) Owned ( ) Donation ( ) Authority to use the school site
______ Location same as given address, if not, attached latest Certificate of
Tax Declaration bears the same address
( ) in the name of the school owner / incorporator
( ) in the name of the lessor
_______ Contract of Lease for a period of at least 5 years
Years and Period of contract _______________________________
_______ Contract to Sell ( ) full payment ( ) with terms of payment in ____ years
_______ Usufruct

Telephone No: +63 02 8742-3122 • 8682-3989 • 8742-4377
_____ 4. Certified true copy of Occupancy Permit (Institutional/Educational)
_____ 5. Pictures

______ Laboratories
______ Science (Gen. Science, Biology, Chemistry and Physics)
_____6. Proposed Annual Budget for the School Year signed by the School Head
_____7. Proposed Tuition and Other School Fees for the School Year signed by the
School Head
_____8. Latest Certificate of Bank Deposit in the name of the school indicative of
_____9. Proposed Curriculum
______ Time Allotment per Grade Level and Subject area
_____ correct _____ not correct
_____10. Updated list of Administrative Officials, Principal, Teaching Personnel and
Non-teaching Personnel
______ Educationally qualified _____ Not qualified
______ Latest Employment Contract/Appointment
______Salary Rate and benefits
( ) within the minimum rate ( ) above the minimum ( ) below the minimum
_____11. School Calendar
_____12. Application/Inspection Fee

Telephone No: +63 02 8742-3122 • 8682-3989 • 8742-4377
Date:__________________________
( ) Incomplete
( ) For issuance of Notice of Deficiencies
( ) Date of Issuance of Notice of Deficiencies _________________
( ) Date of Compliance to Notice of Deficiencies _________________
( ) For issuance of Disapproval

( ) Date of Issuance of Disapproval _________________
_______________________________________________________________________________________
_______________________________________________________________________________________
______________________________________________________________________________
_________________________ __________________________

Telephone No: +63 02 8742-3122 • 8682-3989 • 8742-4377
EVALUATION FORM FOR GOVERNMENT RECOGNITION APPLICATION
Name of School
Old Site
School Location
New Site
School Email
Course/s Applied Grade Level Offerings School Year

Kindergarten
Elementary
SPED
Junior High School
Date Uploaded: __________________
______ 1. Letter of Intent addressed to the Regional Director through the Schools Division
Superintendent.
______ 2. Certified true copy of latest SEC Certificate of Registration and Articles of
Incorporation.
_____ Non-stock Educational Corporation ____ Stock Educ’l. Corporation

_____ Registration Certificate Number
_____ Date of Issuance of SEC Registration Certificate
_____ Term of Corporate Existence
_____ Number of Directors/ Trustees
_____ Amount of Subscribed Capital Stock/ Contribution (must be sufficient
enough to cater to all the needs of the school for at least one year)
______ 3. School Child Protection Policy (SCPP) with Anti-Bullying Policy pursuant to DepEd
Order No. 40, s. 2012 and DepEd Order No. 55 s. 2013 (The Schools Division Office
shall check the submitted SCPP pursuant to their mandate provided under DO 40,
s. 2012).
______ 4. School Site / Documents of Ownership

______ Certified True Copy/ies of Transfer Certificate of Title (TCT) No. ___________
______ Total lot area / Total floor area available (Indicated) __________

Telephone No: +63 02 8742-3122 • 8682-3989 • 8742-4377
______ Location same as given address, if not, attached latest Certificate of Tax
Declaration bears the same address
( ) in the name of the school owner
_______ Usufruct
______ 5. Certified true copy of Occupancy Permit (Institutional/Educational)
______ 6. Inventory/List of Laboratory facilities, equipment, furniture, supplies and material

classified by subject area
______ 7. Inventory/List of Library Holdings classified per subject area or category
______ 8. Inventory/List of Athletic Facilities, Equipment, Supplies and Materials
______ 9. Pictures
______ Laboratories
______ Science (Biology, Chemistry and Physics)
______ 10. Proposed Annual Budget for the School Year signed by the School Head
______ 11. Proposed Tuition and Other School Fees for the School Year signed by the
School Head
______ 12. Latest Certificate of Bank Deposit in the name of the school indicative of

Telephone No: +63 02 8742-3122 • 8682-3989 • 8742-4377
______ 13. Proposed Curriculum

______ Time Allotment per Grade Level and Subject area
_____ correct ______ not correct
______ 14. List of Administrative Officials

____14.1 School Head or the President, Rector, Director or Chief Executive Officer
( ) Bachelors Degree or Masters Degree holder
( ) Filipino
( ) with adequate teaching experience, managerial competence and
technical expertise in school management or background of
demonstrated service in the previous field
( ) of good moral character
( ) full time
_____ Field of Specialization
_____ Certificates of Training
_____ Notarized copy of Employment Contract/ Appointment
_____ NBI Clearance/Police Clearance
_____ Teaching Load, if any
____ 14.2 Principal

_____ Master’s Degree in the Education and with at least five (5) years
Teaching experience
_____ PRC License
____ 14.2.1 Salary Rate and benefits of Administrative Officials and

Principal
( ) within the minimum rate ( )above the minimum ( ) below the minimum
____ 14.3 List of Academic teaching Personnel (Presented in Tabular Form)

____ Kindergarten teachers are holders of Bachelor’s Degree in
Early Childhood Education or Bachelor’s Degree in Elementary
Education with at least 18 units of Early Childhood Education
____ Elementary school teachers are holders of a Bachelor’s Degree in

Elementary Education or its equivalent
____ Secondary school teachers are holders of a Bachelor’s Degree in
Secondary Education or its equivalent

Telephone No: +63 02 8742-3122 • 8682-3989 • 8742-4377
_____ PRC license
_____ Teaching Loads

_____ Full time _____ Part Time
_____ Salaries (per hour/month) and benefits in accordance with
prescribed standards in the Labor Code
_____14.4 List of Non-teaching Personnel (Registrar, Guidance Counselor,

Librarian, Administrative Staff, Nurse etc. presented in Tabular Form with
the following information: Name, Position, Educational Qualification,
Eligibility(if applicable), Employment Status & Salary)
____ Notarized copy of Employment Contract/Appointment

____ Certified true copy of Transcript of Records
____ Copy of Certificates of Related Training (last 3 years)
____ 14.4.1 Salary Rate and benefits of Non-Teaching Personnel

______ 15. Retirement Plan

_____ School initiated retirement plan registered with the BIR
_____ School Certificate of Registration
( ) SSS ( ) Philhealth ( ) Pag-ibig
______ 16. School Calendar

______ 17. Student/ School Manual
______ 18. Application/Inspection Fee

Date:__________________________

Telephone No: +63 02 8742-3122 • 8682-3989 • 8742-4377
( ) Incomplete
_______________________________________________________________________________________
_______________________________________________________________________________________
_________________________________________________________________________________
_________________________ __________________________

Telephone No: +63 02 8742-3122 • 8682-3989 • 8742-4377
EVALUATION FORM FOR RE-ISSUANCE OF GOVERNMENT RECOGNITION APPLICATION
Name of School
Present Address
____ Kindergarten ____ Elementary

Program Offerings
____ SPED ____ Junior High School
School Head Contact Nos.
School’s Email
Date of Application
Purpose of A. End of Corporate Existence
Application
B. Change of School Name
Date Uploaded: __________________
_____ 1. Letter of Intent addressed to the Regional Director through the Schools
Division Superintendent
_____ 2. Copy of latest SEC Amended Articles of Incorporation

_____ 3. Original Copy of DepEd Recognition Certificate/s
_____________________________________________________________________________________
Date Evaluated: __________________
Date:__________________________
( ) Incomplete
( ) Date of Notice of Disapproval __________________

Telephone No: +63 02 8742-3122 • 8682-3989 • 8742-4377
_ _________ __________________ ________

________________________________ ___________________________
_________________________________________________________________________
_________________________ __________________________

Telephone No: +63 02 8742-3122 • 8682-3989 • 8742-4377
Department of Education SDOMar-Form5A-HSP-2022
EVALUATION FORM FOR HOMESCHOOLING PROGRAM APPLICATION

PRIVATE SCHOOL
(DEPED ORDER NO. 001 s. 2022)
Name of School
Old Site
School Location
New Site
School Head Contact Person
Position Telephone No
Email
Course (s) Applied for Status School Year

Kindergarten
Elementary
Junior High School
Senior High School
SPED
FINDINGS ON THE REQUIREMENTS
Date Uploaded: __________________
____1. Letter of Intent addressed to the Regional Director through the Schools Division
Superintendent
____2. Original Copy of Board Resolution to Offer Homeschooling Program as as ADM
____3. Copy of Government Recognition
( ) Kinder ( ) Elementary ( ) JHS ( ) SHS ( ) Special Education
( ) CHED ( ) TESDA
____4. Copy of Homeschooling Program Manual, which includes, but is not limited to,
a discussion of the program standards:
____ Program Management
____ Curriculum
____ Instruction
____ Assessment
____ Others ( e.g. List of Work Immersion Partners for SHS Program)
____5. Homeschool Organizational Chart with the corresponding roles and
responsibilities of each member such as: Homeschool Coordinator,
Homeschool Teacher-Adviser, and/or Learning Area Teachers
_____ Copy of Transcript of Records certified true copy by the issuing institution;
at least BEED or BSED degree holder
( ) Educational qualified ( ) not qualified
_____Certificates of Training (for the last 3 years)
_____Copy of Notarized Employment Contract/Appointment

Telephone No: +63 02 8742-3122 • 8682-3989 • 8742-4377
Department of Education SDOMar-Form5A-HSP-2022
( ) Full time ( ) Part time

____ 6. Certification of availability of learning resources aligned with the K to 12
curriculum
____ Books/ebooks ____ Videos ____ Others
____ 7. Orientation/Training Plan for parents/guardians
____ 8. Annual Homeschooling Program Calendar signed by School Head
______ No. of School Days
____ 9. Schedule of Tuition and Other School Fees signed by School Head
____ Tuition Fees ____ Miscellaneous Fees ____ Other Fees
Date Evaluated: ____________________
Date:__________________________
( ) Incomplete
( ) Date of Notice of Disapproval __________________
___________
_____________________________________
___________________ __________________________________________________
_________________________ __________________________

Telephone No: +63 02 8742-3122 • 8682-3989 • 8742-4377
Department of Education SDOMar-Form7-TOSF-2022
EVALUATION FORM FOR INCREASE IN TUITION AND OTHER SCHOOL FEES APPLICATION
Name of School
School Location
School Head Contact Person
Position Telephone No.
Email
Kindergarten Elementary SpED
Course/s Applied For
JHS SHS
School Year
Date Uploaded: __________________
_____ 1. Letter to the Regional Director, signed by the School Head, indicating among
others the school’s intention to comply with the provision of DepEd Order No. 88, s.
2010 and RA 6728 on the proposed increase
_____ 2. Statement under Oath on the itemized current rates of tuition and other charges
and the corresponding itemized proposed changes thereon as well as the new
fees or charges proposed to be imposed, the increase in percentage not
exceeding 15% (see attached template)
_____ 3. Copy of the latest Audited Financial Statement of the school
_____ 4. Copy of the latest Income Tax Return stamped received by the BIR
_____ 5. Statement under Oath (in one page) signed by the school head that:
_____ 5.1 a prior consultation on the proposed increase was conducted with the
duly organized student government with the parents of the students, teachers
association, and faculty associations
_____ 5.2 the authorized representatives of the said associations were furnished a
copy of the audited financial statement of the school, the same with the copy
attached to the application
_____ 5.3 70% of the proceeds of the proposed increase shall be allocated for
payment of salaries or increase in salaries, wages, allowances and other benefits
of teaching and non-teaching personnel except administrators who are principal
stock holders of the school; that 20% shall go to the improvement or modernization
of buildings, equipment, libraries, laboratories, gymnasium and other facilities and
to payment of other cost of operations
_____ 5.4 the school head is aware that failure to comply with the foregoing
requirements shall forfeit the right of the school to increase its tuition fee or collect
the same
_____ 5.5 the increase of tuition/other fees previously collected went to the
payment of salaries and salary increase, wages, allowances and other benefits of
teaching and non-teaching personnel except administrators who are principal
stockholders of the school; that 20% thereof was used for the improvement or
modernization of school buildings, equipment, libraries, laboratories, gymnasium
and other facilities and other costs of operation

Telephone No: +63 02 8742-3122 • 8682-3989 • 8742-4377
_____ 6. Minutes of the consultation showing the date of the meeting, objections made
by the organizations and counter-proposals offered, and other information
_____ 7. List of attendees with their addresses and signatures
_____ 8. Other documents such as Notice of Consultation duly acknowledged by the
concerned organizations, and pictures or video during the consultation
_______________________________________________________________________________________

( ) Accomplished Evaluation Form
Date:__________________________
( ) Incomplete
________________________________________________________________________________________
________________________________________________________________________________________
_______________________________________________________________________________
_________________________ __________________________

Telephone No: +63 02 8742-3122 • 8682-3989 • 8742-4377
(Attachment)
STATEMENT UNDER OATH ON THE ITEMIZED SCHOOL FEES

NAME OF SCHOOL
ADDRESS
Grade Approved Fee Proposed Fee Amount of % of

FEES Increase
Level SY _____ SY ______ Increase
1 TUITION Php
MISC. FEES
(e.g.)
Medical/Dental
Guidance
Laboratory
OTHER FEES
Learning Mgmt.
System
TOTAL MF & OF
Prepared by: Approved:
__________________________ _________________________________
________________________________________________________________________________________
Republic of the Philippines)

______ City ) SS
SUBSCRIBED AND SWORN to before me this ____ day of _____ affiant exhibiting to
me his ____________________ issued at ________________ on ___________________.
Doc No. ___________

Page No. __________
Book No. __________
Series of 20_________

Telephone No: +63 02 8742-3122 • 8682-3989 • 8742-4377

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Division Memorandum No. 106 s. 2022 - Various Forms for Application of Private Schools Government Permit Recognition, Reissuance of Recognition, Homeschooling Program, and Increase of Tuition and Other School (1)

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June 29, 2022

VARIOUS FORMS FOR APPLICATION OF PRIVATE SCHOOLS

TO: Acting Assistant Schools Division Superintendent

2. Documentary requirements must be submitted in hard copy with proper earmark.

Regional Office SDO Marikina Applicable Form

Address: 191 Shoe Avenue, Sta. Elena, Marikina City

5. Immediate and wide dissemination of this Memorandum is desired.

Address: 191 Shoe Avenue, Sta. Elena, Marikina City

EVALUATION FORM FOR NEW GOVERNMENT PERMIT APPLICATION

Course/s Applied Grade Level Offerings School Year

Date Uploaded: __________________

_____ Non-stock Educational Corporation ____ Stock Educ’l. Corporation

Address: 191 Shoe Avenue, Sta. Elena, Marikina City

______ 4. Notarized Feasibility Study, covering comprehensively the following factors,

______ 5. School Site / Documents of Ownership

(2) construction of school buildings/facilities on said school site within ten

Address: 191 Shoe Avenue, Sta. Elena, Marikina City

Years of contract ______________

______ 6. Certified true copy of Occupancy Permit (Institutional/Educational)

______ 7. Inventory/List of Laboratory facilities, equipment, furniture, supplies and material

______ 8. Inventory/List of Library Holdings classified per subject area or category

______ 9. Inventory/List of Athletic Facilities, Equipment, Supplies and Materials

______ 10. Pictures

______ 14. Proposed Curriculum

Address: 191 Shoe Avenue, Sta. Elena, Marikina City

______ Time Allotment per Grade Level & Subject Area

______ 15. List of Administrative Officials

____ 15.2 Principal

____ 15.2.1 Salary Rate and benefits of Administrative Officials and

____ 15.3 List of Academic teaching Personnel (Presented in Tabular Form)

Address: 191 Shoe Avenue, Sta. Elena, Marikina City

prescribed standards in the Labor Code

_____ Notarized copy of Employment Contract

_____15.4 List of Non-teaching Personnel (Registrar, Guidance Counselor,

____ Notarized copy of Employment Contract/Appointment

____ 15.4.1 Salary Rate and benefits of Non-Teaching Personnel

______ 16. Retirement Plan

______ 17. School Calendar

______ 18. Student/ School Manual

______ 19. Application/Inspection Fee

Date Evaluated: _______________

Address: 191 Shoe Avenue, Sta. Elena, Marikina City

Evaluated by: Noted:

Address: 191 Shoe Avenue, Sta. Elena, Marikina City

EVALUATION FORM FOR RENEWAL OF GOVERNMENT PERMIT APPLICATION

Course/s Applied Grade Level Years in School Year

Date Uploaded: __________________

Address: 191 Shoe Avenue, Sta. Elena, Marikina City

_____ 4. Certified true copy of Occupancy Permit (Institutional/Educational)

______ Classrooms ______ Medical & Dental Clinic

Address: 191 Shoe Avenue, Sta. Elena, Marikina City

Date Evaluated: _______________

( ) For issuance of Disapproval

Evaluated by: Noted:

Address: 191 Shoe Avenue, Sta. Elena, Marikina City

EVALUATION FORM FOR GOVERNMENT RECOGNITION APPLICATION

Course/s Applied Grade Level Offerings School Year

Date Uploaded: __________________

_ Non-stock Educational Corporation Stock Educ’l. Corporation

Classrooms Medical & Dental Clinic

_ Non-stock Educational Corporation Stock Educ’l. Corporation

Kindergarten Elementary

_ _ __