Commission on Higher Education
  GPR Form B
 
CHED FORM NO. GPR. B

APPLICATION FOR GOVERNMENT PERMIT
(For Renewal Permit/GR)
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. Updated pictures of the school site and building(s), classroom, laboratories, libraries, medical and dental health facilities, canteens, sports and recreational areas, etc.

______2. Copy of the latest financial statement for the existing programs certified by an independent Certificate Public Accountant (for existing schools only)

______3. Proposed budget/annual expenditures per program for the five (5) succeeding school years approved by the Board of Trustees/Directors

______4. Contents noted curriculum / Syllabi that should include the number of hours, course/subject descriptions, etc.

______5. Contents noted schedule of tuition and other authorized school fees

______6. Matrix list of school administrators, i. e., President, Vice-President (s), Deans, Department Heads, etc, including:

                    a. Educational qualifications, where and when obtained
                    b. Position/designation
                    c. Status of Employment d. Rate of salary per month
                    e. Other Employment benefits in accordance with prescribed standards
                    f. Relevant Experience/s
                       _____ Transcript of Records
                       _____ Copy of License or Eligibility
                       _____ Notarized contract of Employment/Appointment with conforme of appointee

_____7. 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 with conforme of appointee)

 ______8. 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 with conforme of appointee
                        ______ Faculty Development Plan

______9. 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 with conforme of appointee

______10. 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: __________


______11. Matrix list of laboratory facilities, equipment, furniture, supplies and materials classified by area

______12. 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

______13. Matrix list of athletic facilities, equipment, supplies and materials

______14. Inspection fee in the amount of Four Thousand pesos (P4,000.00) per program O.R. No.________________________


                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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