Commission on Higher Education
  GPR Form A
 

CHED FORM NO. GPR. A

 

APPLICATION FOR GOVERNMENT PERMIT
(For New Programs)
In two (2) sets of application folders

 

 

The Honorable Chairperson                                     Date: ________________
Commission on Higher Education
Office of the President
5th Floor, DAP Bldg., Ortigas Center
San Miguel Ave., Pasig City

 
Through channels

 
Sir:

           The undersigned Chairman of the Board of Trustees/President of __________________________________at__________________________________________

               (Name of School)                              (Address of School)
 
hereby petition for GOVERNMENT PERMIT/RECOGNITION to operate the following course under the laws  of the Republic of the Philippines.
 
                 COURSE                                    CURRICULUM YEAR
 
_____________________________                __________________        
         
 
          To support this petition are the following documents duly certified / authenticated:
 
______1. Board Resolution on the operation of the new courses certified by the Corporate Secretary
 
______2. Feasibility study for the next five (5) years indicating the need and relevance of the course to the development of the community and the resources and capabilities of the corporation / school to achieve / implement the objective of developing the community
 
______3. Articles of Incorporation and By-laws (to include Amendments, Purposes, etc.)
               ____Duly registered with the Securities and Exchange Commission
            ____In the name of the school
            ____In the area of operation
            ____Stock       _____Non-stock
 
______4. Copy(ies) of the Transfer Certificate(s)  of Title (TCT) of the school site
            _____ 25-year lease of contract (certified photocopy)
            _____ In the name of the school
            _____ Adequate area stated (indicate total land area): ____________sq. meters
 
______5. Statement on the location of the school in relation to recreational places of questionable character and gambling establishments, bowling alleys, movie houses, markets, garbage dumps, funeral parlors, cemeteries, heavy traffic highways, jails, railroads yards, dancing halls and manufacturing and industrial establishments, and the like (Must be free from noise, unpleasant odor and dust, should be sufficiently  far from the above places)
            _____ Certification from the Local Government Unit
 
______6. Institutional Development and Campus Landscaping plans
              _____Blueprint of Campus Development/Landscaping Plans
              _____With vertical and lateral expansion potentials
 
 
______7. Certificate of occupancy of the school building(s) from the proper city/municipal authorities in the name of the owner/lessor
 
______8. Updated pictures of the school site and building(s), classroom, laboratories, libraries, medical and dental health facilities, canteens, sports and recreational areas, etc.
 
______9. Copy of the latest financial statement for the existing programs certified by an independent Certificate Public Accountant (for existing schools only)
 
______10. Proposed budget/annual expenditures per program for the five (5) succeeding school years approved  by the Board of Trustees/Directors
 
______11. Proposed curriculum. The curriculum should conform with CHED Policies and Standards and the syllabi should include the number of hours, course/subject descriptions, etc.
 
______12. Proposed schedule of tuition and other authorized school fees per program
 
______13. Employees’ Social Benefits
                _____SSS      Latest O.R. No._____________ Date:________         
                _____HDMF   Latest O.R. No._____________ Date: _______
                _____Retirement Membership Latest O.R. No. ___________Date_____________
                  (include contribution of the individuals covered by the said retirement plan)
                ____Others    Latest O.R. No._____________ Date:________         
 
______14. Matrix list of school administrators, i. e., President, Vice-President (s), Deans, Department Heads, etc, including:
 
    1. Educational qualifications, where and when obtained
    2. Position/designation
    3. Status of Employment
    4. Rate of salary per month
    5. Other Employment benefits in accordance with prescribed standards
    6. Relevant Experience/s
                _____ Transcript of Records
                _____ Copy of License or Eligibility
                _____ Notarized contract of Employment/Appointment with conforme of appointee
 
_____15. Matrix list of Academic Non-Teaching personnel including (Registrar, Librarian, Guidance Counselor, Researcher)
 
            a.      Educational qualifications, where and when obtained
            b.      Field/s of specialization
            c.      Status of Employment
            d.      Rate of salary per hour / month
            e.      Other Employment benefits
            f.       Relevant Experience/s
                _____  Transcript of Records
                _____  Copy of License or Eligibility
                _____  Notarized contract of Employment/Appointment / Notarized Intent of Employment with conforme of appointee
 
______16. Matrix list of Teaching / Academic staff including:
 
            a.      Educational qualifications, where and when obtained
            b.      Field/s of specialization (per program basis)
            c.      Subject assignments/loads
            d.      Status of Employment
            e.      Number of teaching / contact hours per week
            f.       Rate of salary per hour/ month
            g.      Other Employment benefits
            h.      Relevant Experience/s
                 ______ Transcript of Records
                 ______ Copy of License or Eligibility
                 ______ Notarized contract of Employment/Appointment / Notarized Intent of Employment with conforme of appointee
                 ______ Faculty Development Plan
  
______17. Matrix list of Non-Academic Personnel including:
            a.      Educational qualifications, where and when obtained
            b.      Position/designation
            c.      Status of Employment
            d.      Rate of salary  per month /day
            e.      Other employment benefits
            f.       Relevant Experience/s
                ______Transcript of Records
                ______ Copy of License or Eligibility
                ______ Notarized contract of Employment/Appointment / Notarized Intent of Employment with conforme of appointee

______18. Matrix list of laboratory facilities, equipment, furniture, supplies and materials classified by area
 
______19. Matrix list of library holdings, classified into Cultural, Filipiniana and Professional (professional books are limited to the course applied for)
                _____ Five (5) titles per professional subject-with 10 book copies per title
                _____ Five (5) year Library Development Plan
                    _____ Internet Access/CD-ROM
 
______20. Matrix list of athletic facilities, equipment, supplies and materials
 
______21. Inspection fee in the amount of Four Thousand pesos (P4,000.00) per program
 
_______22.  School bond with CHEDRO-III (for new schools) in the amount of Six  Thousand pesos (P 6,000)
 
 
        I, as Chairman of the Board / President, promise to maintain the standards required for this course and to follow faithfully all the laws, the rules and regulations, and the requirements of the Commission on Higher Education governing the operation of authorized private school courses and to inform the CHED of any plan or action regarding closure or phasing out of the course or any changes in the prescribed requirements. I acknowledge that any violation of the laws, the rules and regulations, and the requirements of the Commission on Higher Education shall be deemed sufficient cause for the revocation of the authority granted.
 
            The school will not hold classes in the course/s applied for above until and unless this application is approved and the corresponding Government Permit is issued by the Commission on Higher Education.
Very respectfully yours,
 
 
                                                                                                                            
                                                         Signature over Printed Name
                                                         (Chairman of the Board / President)
  
 
Republic of the Philippines              
City / Municipality of _____________________
Province of _____________________________
 
 
          I, __________________________________of the Board of Trustees / President of
                   (Chairman of the Board/President)
 the ____________________________________ Filipino, of legal age and resident  of the
                             (School)
Philippines, after having been sworn to in accordance with law depose and say information in this application and in the supporting documents are true and correct.
 
 
 
 
                                                                                                                                                                                                _______________________________
                                                                 (Chairman of the Board/President)
 
 
          SUBSCRIBED AND SWORN to before me this ______ day of ______________ 200__.  The affiant exhibits his /her Residence Certificate No. ___________________ issued at ___________________________________on ________________________.
 
 
 
                                                                   _______________________________
                                                                                                                                                   (Notary Public)
 
 
 
 
Doc. No. ___________
Page No.___________
Book No. ___________
Series of ___________
 
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