Republic of the Philippines

OFFICE OF THE OMBUDSMAN

Agham Road

North Triangle

Diliman

Quezon City 1128

Honorable CONCHITA CARPIO MORALES

Ombudsman
Agham Road, Diliman , Quezon City
Re:

APPLICATION FOR CAMPUS INTEGRITY

CRUSADERS (CIC) ACCREDITATION

Dear Ombudsman Morales:

The

Applicant, _____________________________

(name of

student-organization),

__________________________

(name

school),

_____________,

President,

Division

of

through

its

of

___________________________, as duly authorized representative;

to this Honorable Office respectfully applies for CIC Accreditation with
the

following

documentary

requirements,

per

Section

5 C

of

Memorandum Circular No. 04, Series of 2012:

1. Certificate of Recognition issued by the School Principal/Dean
of Student Affairs (Annex A);
2. List of organizations officers and members (Annex B);
3. Letters of Indorsement and Commitment signed by the School
Principal/Dean and the designated Adviser (Annes C); and
4. Proposed activities
(Annes D).

for

the

School

Year

____________

For your Honors consideration.

_________________________________
Name of the Organization-Applicant

_________________________________
President/Authorized Representative
(Signature over Printed Name)

Annex A

CERTIFICATE OF RECOGNITION

This is to certify that __________________________________

(name of organization) is a duly recognized student organization of
_______________________________ (name of school), Division of
________________.
This Certification is issued for the abovenamed organizations
application for accreditation as Campus Integrity Crusaders (CIC) of
the Office of the Ombudsman.

_______________________
Principal/Dean
(Signature over Printed Name)

LIST OF OFFICERS FOR SY 2016-2017

LIST OF MEMBERS FOR SY 2016-2017

Annex C1

Honorable CONCHITA CARPIO MORALES

Ombudsman
Agham Road, Diliman, Quezon City

Re:

Designation of student organization Adviser

Dear Ombudsman Morales:

This is to respectfully indorse Mr./Ms/Mrs. _________________

as the Adviser of _____________________________ (name of
organization), ____________________ (name of school), Division of
_________________,

which

has

pending

application

for

accreditation as OMB Campus Integrity Crusaders (CIC) for the School

Year _____________.
Attached is the Letter of Commitment signed by the undersigned
and the aforementioned Adviser.
For your honors consideration.
Respectfully yours,
________________________
Principal/Dean
(Signature over Printed Name)

Annex C2

LETTER OF COMMITMENT

We, ___________________________________, Principal of

___________________________________
_______________________________,

(name of

designated

school) and
Adviser

of

___________________________ (name of organization), Division of

___________, hereby commit to support the accredited CIC of our
school in their activities for the School Year ______________, in line
with

the

principal

purpose

of

empowering

the

youth

in

their

involvement in corruption prevention initiatives by developing their

leadership skills and instilling the values of integrity and social
responsibility, in partnership with the Office of the Ombudsman.

____ day of ________, _______________, Philippines.

________________________
Principal
(Signature over Printed Name)

________________________
Adviser
(Signature over Printed Name)

Annex D

Name of student-organization:

_____________________________________

Name of School:

_____________________________________

PROPOSED ACTIVITY

FOR SCHOOL YEAR 2016-2017

Title of Activity:

____________________________________
____________________________________

Description:

____________________________________
____________________________________
____________________________________

Objective/s:

____________________________________
____________________________________
____________________________________

Implementation
Strategies:

____________________________________
____________________________________
____________________________________

Date of
Implementation:

____________________________________
____________________________________
____________________________________
Submitted by:

__________________________
President
(Signature over Printed Name)

__________________________
Adviser
(Signature over Printed Name)
Noted by:
__________________________
Principal/Dean
(Signature over Printed Name)