SENIOR HIGH SCHOOL

OFF-CAMPUS LEARNING DAY SCHOOL ACCESS

PLEASE PRINT

PERSONAL INFORMATION ACADEMIC INFORMATION

LAST NAME ID NUMBER
FIRST NAME STRAND
MIDDLE NAME SECTION
REQUEST
DATE FILED
NUMBER OF REQUESTED DAY/S
DATE/S OF ENTRY (limited only to 1 week)

TIME OF ENTRY
DATE/S OF EXIT (must coincide with the date of entry)

TIME OF EXIT
VENUE/S OF ACTIVITY

REASON/S

TERMS AND CONDITIONS

1. This form must be accomplished in duplicate (2 copies) and must be submitted at least three (3) days
before the start date to the designated department/s for approval and signature:
a. This form must be endorsed by your Class Adviser, Strand Coordinator or OSAS representative
b. All academic and co-curricular activities must be approved by the SHS Academics Department.
c. All non-academic and extra-curricular activities (e.g., school org events) must be approved by the
Office of Student Affairs and Services (OSAS) Department.
2. This form must be presented to the security personnel on the date/s of entry
3. The student is not allowed to go out of iACADEMY Nexus campus before the time of exit.
a. In case the student needs to go out before the time of exit. The student’s parents/ guardian must
send a letter of permission via email to the SHS Principal, Mr. Paolo Noceda at
paolo.noceda@iacademy.edu.ph
4. By signing this form, the parents are allowing their child to go to school to attend the school-related activity.

Student’s Signature Over Printed Name Parent/ Guardian’s Signature Over Printed Name
APPROVAL
Endorsed by: Approved by: SHS ACADEMICS

Name & Designation / Signature Name & Designation / Signature

Approved by: OSAS

Name & Designation / Signature