CHED Form E.

5 (revised June 2001) Unique Institu

FACULTY OR TEACHING STAFF IN HIGHER EDUCATION PROGRAMS 1st sem/Trim
Name of Institution:
Region: _________

PLEASE READ THE ATTACHED INSTRUCTIONS BEFORE YOU FILL OUT THIS FORM.

Name of Full-Time/ Sex Primary Educational Credential Earned Professional Tenure Faculty
Faculty Part-Time Teaching Baccalaureate Master's Doctorate License of Rank
Discipline Employment
(LN, FN MI) (use Code) (M or F) (use Code) (no abbreviation please) (use Code) (use Code) (use Code)
EXAMPLE:
DELA CRUZ, JUAN V. 1 M 460100 BS in Mathematics MS in Mathematics Ph.D. Mathematics (18 units) 24 1 20
PLS. START YOUR ENTRY BELOW THIS ROW. INSERT MORE ROWS AS NEEDED.

Accomplished by: Certified Corre

Designation: Designation:
Date: Date:
Unique Institutional Identifier:
1st sem/Trimester Academic Year: 2009/10

Teaching Subjects Annual

Load Taught Salary

(use Code) (please enumerate) (use Code)

30 Algebra 1 & 2, Trigonometry, Differential & Integral Calculus 8

Certified Correct:
Designation:
Date: