Republic of the Philippines

APAYAO STATE COLLEGE

Conner, Apayao
Official website: www.asc.edu.ph
E-mail address: ascofficeofthepresident@gmail.com & op_asc@yahoo.com

REQUEST FORM OF THE FACULTY

PERSONAL INFORMATION
LAST NAME: Age:
FIRST NAME, EXT.: Gender:
MIDDLE NAME:

HIGHEST EDUCATIONAL ATTAINMENT

DEGREE:
NAME OF HEI:
YEAR GRADUATED:

CURRENT EMPLOYMENT STATUS

CURRENT FACULTY RANK:
MODE OF APPOINTMENT:
DATE OF APPOINTMENT:
NAME OF SUC:
CAMPUS:
ADDRESS:

Attached to this request form are my self-accomplished Individual Summary

Sheet (ISS) and its attached forms, checklist of evidence submitted, and
photocopy of the sets of evidence based on my ISS. The electronic copies of
the ISS and the evidence are available in my google drive. I will willingly share
them with the Evaluation Committees to validate the information submitted.

I confirm that the information provided in this request for position

reclassification is completely accurate, precise, and comprehensive. I am
aware that any misrepresentation of these records may result in my
disqualification from position reclassification for the current evaluation period.

<Signature and Printed Name of Faculty>

<date signed>

CHEERS SUCs
“Cordillera Higher Education Evaluation and Reclassification System for Faculty Members of
State Universities and Colleges – IRR of JC No.03 s. 2022”
 Republic of the Philippines
APAYAO STATE COLLEGE
Conner, Apayao
Official website: www.asc.edu.ph
E-mail address: ascofficeofthepresident@gmail.com & op_asc@yahoo.com

REQUEST FOR AUTHENTICATION OF DOCUMENTS

August ___, 2023

MARLINA S. CABILATAZAN
HRMO II

Dear Mrs. Cabilatazan:

Relative to the implementation of DBM-CHED Joint Circular No. 3, series of 2022, this is
to humbly request for the authentication of the following documents of evaluation by the
Institutional Evaluation Committee (IEC), to wit:

1. Title of Document 1
2. Title of Document 2
(include documents as needed)

Very truly yours,

Name and Signature Above

CHEERS SUCs
“Cordillera Higher Education Evaluation and Reclassification System for Faculty Members of
State Universities and Colleges – IRR of JC No.03 s. 2022”
 Republic of the Philippines
APAYAO STATE COLLEGE
Conner, Apayao
Official website: www.asc.edu.ph
E-mail address: ascofficeofthepresident@gmail.com & op_asc@yahoo.com

LETTER OF APPEAL

Date:

RONALD O. OCAMPO, PhD

IEC Chair

Sir/ Madam:

I, (Name of Faculty), would like to appeal for the re-evaluation of my documents

particularly on the following:

Key Results Area Indicator/ Criteria Document

1. Instruction
2. Research, Invention and
Creative Work
3. Extension Services
4. Professional
Development

Hoping for your consideration and immediate action on the aforesaid request. Thank you.

Truly yours,

Name of Faculty
Academic Rank

CHEERS SUCs
“Cordillera Higher Education Evaluation and Reclassification System for Faculty Members of
State Universities and Colleges – IRR of JC No.03 s. 2022”