CHED FORM NO. GPR.

APPLICATION FOR GOVERNMENT PERMIT/RECOGNITION

TO OPERATE (See below)
FOR SCHOOL YEAR _____________

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/Madam:

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 courses under the laws of the Republic of the Philippines.

COURSES CURRICULUM YEAR(S)

__________________________________________ ____________________
__________________________________________ ____________________
__________________________________________ ____________________

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 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 duly registered with the

Securities and Exchange Commission. (For new schools or existing
schools that have not yet submitted this document).

4. Copy(ies) of the Transfer Certificate(s) of Title (TCT) of the school site.

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).

6. Campus development and landscaping plans.

7. Documents of ownership of the school building(s). (For new School).

8. Certificate of occupancy of the school building(s) from the proper

city/municipal authorities.

9. Updated pictures of the school site and building(s), classroom,

laboratories, libraries, medical and dental health facilities, canteens,
sports and recreational areas, etc.

10. copy of the latest financial statement for the existing programs
certified by an independent Certificate Public Accountant. (For existing
school only).

11. Proposed budget/annual expenditures for the succeeding school

year approved by the Board of Trustees/Directors.

12. Proposed curriculum submitted and noted by CHEDRO XIII.

13. Proposed schedule of tuition and other school fees.

14. Copy of retirement plan of the school registered with the

Securities and Exchange Commission (For existing school that have not
yet submitted this document).

15. List of school administrators, i. e., President, Vice-President (s),

Deans, Department Heads, etc, including:

a. education qualification, where and when obtained

b. Position/designation
c. Full time/part time
d. Rate of salary per month
e. Other employee benefits

16. List of Academic Non-Teaching personnel including:

a. education qualification, where and when obtained

b. fields of specialization by degree
c. subject assignments
d. full time / part time
e. number of teaching / contact hours per week
f. rate of salary per hour / month
g. other employee benefits
h. outside employment, if any

17. List of Teaching / Academic staff including

a. educational qualifications, where and when obtained

b. fields of specialization
c. subject assignments
d. full time / part time
e. number of teaching / contact hours per week
f. rate of salary per hour/ month
g. outside employment , if any

18. List of Non-Academic Personnel including

 a. educational qualifications, where and when obtained
b. position/designation
c. full time / part time
d. rate of salary per month /day
e. other employee benefits

19. Contracts of prospective deans and faculty members to serve

the school.

20. List of laboratory facilities, equipment, furniture, supplies and

materials classified by subject area.

21. List of library holdings, classified into Cultural, Filipiniana and

Professional (Professional books are limited to the course applied for.)

22. List of athletic facilities, equipment, supplies and materials.

23. Inspection fee in the amount of Four Thousand (P4,000.00) per

program to be paid in the Commission on Higher Education CARAGA
Regional Office XIII, Butuan City.

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 prescribes 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 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,

(Chairman of the Board / President)

Notary Public….