APPLICATION NO: _______________ TIPM-OSA-015

Revision Status/Date: 3 / 2017 December 8

TECHNOLOGICAL INSTITUTE OF THE PHILIPPINES Privacy Consent

I understand and agree that by filling-out this form I am allowing the Technological Institute of the Philippines
APPLICATION FOR THE USE OF SCHOOL FACILITIES (T.I.P.) to collect, use, and disclose my personal information for Use of Facilities Application and to store it
as long as necessary for the fulfillment of the stated purpose in accordance with applicable laws, including
the Data Privacy Act of 2012 and its Implementing Rules and Regulations, and the T.I.P. Privacy Policy.
The purpose and extent of collection, use, sharing and disclosure, and storage of my personal information
was explained to me.
Please tick the appropriate circle of the school facility you want to use:
Casal Seminar Room Arlegui Seminar Room Congregating Area PE Center
Others:

Gemma S. Pepito
Name of Applying Student/Employee: ____________________________________________________________ ECE - Staff
Designation: __________________________
ECE Department
Organization/Department: _______________________________________________________________________ April 25, 2023
Date Filed: ___________________________
ECE Alumni Homecoming
Title of Activity: ____________________________________________________________ April 29, 2023
Date/s of the Activity:_______________________________
3:00 pm 8:30 pm
Time Duration of Activity: From:___________________________To:________________________________Expected 50
Attendance: __________________
Reminders:
1. Parties who wish to use any of the school facilities shall first check with the 6. No nails, screws, or bolts shall be driven through the floors of the venue
OSA for the availability of the venue before accomplishing this form. in putting up decorations or announcements. All decorations shall be set-up
Accomplished form must be submitted in five (5) copies one (1) week in coordination with the Maintenance Supervisor or his/her staff. The
before the event. Attach the following documents: organization/department shall assume responsibility in preparing the place.
a.) Approved application to conduct activity Removal of posters, streamers, and other similar items and cleaning up the
b.) Approved project proposal venue is likewise the responsibility of the organization/department as stated
c.) Program flow in item number five (5).
d.) Evaluation form measuring the objectives of the activity. 7. The Seminar Room shall be occupied by not more than 150 persons
2. The event must be limited to a minimum of two (2) hours and a maximum of for P. Casal Campus and 130 persons for Arlegui Campus.
eight (8) hours. The organization/department MUST observe the maximum capacity.
3. The venue MUST NOT be used other than the purpose stated in the 8. No pyrotechniques and/or flammable materials (e.g. candles, firecrackers,
Title of Activity above. etc.) will be allowed as "props" in the duration of the activity.
4. The organization/department shall be held responsible for any damage to the 9. Activity Report and/or Liquidation report must be submitted not later than
venue. one (1) week after the event.
5. 5S must be observed at all times in the conduct of the activity in the venue. 10. Only accredited caterers will serve food during school events. The school
cafeteria concessionaire is one of the accredited caterers of school events.
I will abide by the above guidelines on using the school facilities.
Gemma S. Pepito

Signature over Printed Name of the Student/Employee

Recommending Approval:
Please check the appropriate box of the equipment needed:
APPROVED
Equipment: Engr. Nelor Jane Agustin
Quantity: DISAPPROVED
Tables 2 goes here>
<text Faculty Adviser / Date
50 Signature over Printed Name
Chairs <text goes here>
Microphone <text goes here>
Engr. Rommel M. Anacan
Sound System
Projector
Department Officer / Date Head, Office of Student Affairs
Signature over Printed Name
Podium
Philippine Flag Date: ______________
T.I.P. Flag
Head, PE Department / date
Others: Signature over Printed Name NOTED:
(Please separate with a comma and specify the quantity.) (for PE Center reservation) Head, Maintenance Department:
________________________________________
________________________________________ _____________ Date:
________________________________________ ______
NOTED: NOTED:
________________________________________ Head, SOHAS Head, MDS (for sports activities)

_____________ Date: ______ ______________ Date: ______