Republic of the Philippines

Department of Education
Region III
DIVISION OF GAPAN CITY
San Vicente, Gapan City
APPLICATION FOR PERMISSION TO STUDY
Name of Applicant: _______ MA. ELAINE CHRISTINE S. PAGUIO_____ Position: _______Teacher I________
Civil Service Eligibility: ____________LET___________ Civil Service Status: ___
__Passed_________
Name of School Where Employed: _______Bungo__E/S_________ Barrio: ____ _______ N/A_______________
Municipality: _______________Gapan________________________ Civil Status: ______Married_____________
Distance in Kms. Between Official station and college where enrolled: ____________Approx. 83 kms.__________
(Name and Location of College where applicant wishes to enroll)
Course Applied for: ___SAN JOSE COLLEGES / SAN JOSE, NUEVA ECIJA_______
Academic Year: _____2016-2017____ Sem./Summer:
1st
2nd
3rd
4th
Course to be taken this term and the schedule:
COURSE
Master in Education Management

DAYS IN THE WEEK

Saturday

HOURS OF THE DAY

8:00 5:00

Credits of units towards . Masteral Degree

Total No. of units previously earned _______________________27 units_______________
No. of Units to be earned this Qrt./Sem./Summer: ______________9 units_______________
I hereby certify that I have carefully read Circular No. 17, s. 1960, dated June 20, 1960 and Division Letter No.
73, dated July 1960, and the information on the next page of this form, all the provisions of which I am bound to observe
very strictly. I understand that the regulations on outside study of teachers are intended primarily to safeguard the health
of the teacher as well as of course to maintain their efficiency in the service. I also understand that if in the opinion of the
School Division Superintendent, the study is affecting adversely my efficiency as teacher, this permission may be
revoked.
Date Submitted: _________June 13, 2016__

MA. ELAINE CHRISTINE S. PAGUIO

(Name and Signature of Applicant)

APPROVAL RECOMMENDED
The undersigned shall require strict compliance by the applicant with all the existing rules and regulations
regarding permission to study, and hold him/her responsible for any undue delay in forwarding the application to the
office doing very satisfactory work with an efficiency rating of ABOVE Average or higher. The applicant will be
required to submit through this office, to the Division Superintendent, a certified true copy of the report ratings obtained
in the course which should be attended for outside study not earlier than thirty minutes (30 min.) after the afternoon
session in the public school.
Date Submitted: ___June 13, 2016____

AURORA A. LAVILLA
School Principal

APPROVED:
Date: ________________________
Permit No.: ___________________
Term: ________________________

SILVERLINA A. DE JESUS
OIC/Schools Division Superintendent

APPLICATION FOR PERMISSION TO STUDY

INSTRUCTIONS
1. Application for permission to study in five (5) copies must reach the office not later than two (2) months
before the start of the actual classes. The teacher must file the request before enrolling for the first time in any
school, college or university.
2. The teacher-applicant must be doing very satisfactory work with an efficiency rating of ABOVE
AVERAGE or higher.
3. The permission is given until the applicant completes the curriculum towards a degree. He/She does not need
to file a request for permission every semester.
4. A certification from the head of the school or college where the teacher is enrolled and the subject to be
pursued should be attached with the application.
5. Teachers who are about to finish the course, or have started a course as well as the subject already completed
and those still to be taken, all to be certified by the registrar of the private schools concerned.
6. After each semester every teacher granted permission to study should submit to the superintendents office,
through channel, a certified true copy of the report of ratings obtained in the course/s enrolled. After
graduation he/she should submit a complete set of his/her transcript of records or grades, and special order to
the superintendent through immediate superior, for validation and verification.
7. The maximum study of nine (9) units per semester or summer should be strictly observed. The teachers who
are candidates for graduation may be allowed to carry from one (1) to three (3) units over the nine units (9)
authorized provided that those units are the last units needed to enable them to graduate. No exception will be
given where teachers do not fall under the above status/conditions. Violations of this regulation on study load
shall be sufficient cause for revocation of the permission to study and for administrative action.
8. The college, school or university in which the teachers contemplated enrolling should be accessible to his/her
official stations so that he/she will be unduly compelled to hurry therefrom in order to arrive at his/her class
time. The teacher should attend to his/her outside study not later than thirty (30) minutes after the afternoon
session in the public school.
9. The immediate supervisor shall be held strictly responsible for any undue delay in forwarding the application
to the Superintendent, if the application to the Superintendent has been filed on time.
SAN JOSE COLLEGES / SAN JOSE, NUEVA ECIJA
(Name and Location of College where the applicant wishes to enroll)

C E R T I F I C AT I O N
TO WHOM IT MAY CONCERNS:
This is to certify that ____MA. ELAINE CHRISTINE S. PAGUIO __ a Elementary/ Secondary School Teacher is
seeking admission in this college to ______________enroll Masters in Education______
_with the following subjects offered this ____________________________________________________.
SUBJECT

____________________________________
Dean

DAYS OF THE WEEK

HOURS OF THE DAY

__________________________________
Registrar