Republic of the Philippines

DEPARTMENT OF EDUCATION
NATIONAL CAPITAL REGION
SCHOOLS DIVISION OFFICE
CALOOCAN CITY
DEPED-NCR GPR FORM1

APPLICATION FOR GOVERNMENT PERMIT

Name of School:
Old Site
School Location:
New Site
School Head: Contact Person:
Position: Telephone No:
Course (s) Applied for Status School Year
Nursery/Kinder/Preparatory
Elementary
Secondary
SPED
Senior High School
FINDINGS ON THE REQUIREMENTS
____New ___Renewal ___ Recognition Date filed: _________
______ 1. Application Letter (application filed on time)
______ 2. SEC. Certificate of Registration with Articles of Incorporations and By-Laws in the name of the school
Purposes: ( ) Preschool ( ) Elementary ( ) Secondary ( ) SPED ( ) Senior HS
____ Non-stock educational corporation ____ Stock Educational Corporation
____ Date of Inssuance of SEC Registration Certificate
____ Registration Certificate No.
____ Term of Corporate Existence
____ Numbers of Directors / Trustees
____ Amount of subscribed Capital Stock/ Contribution (must be sufficient enough to cater to
all the needs of the school for atleast one year)
______ 3. Anti-Bullying Policy/Child Protection Policy with Anti-Bullying Policy (mandatory per Sec.13 of the
IRR of R.A. 10627)
______ 4. Notarized Feasibility Study, stating the following, supported by evidence:
_____ Purpose and objectives of the proposed school or course
_____ Existing schools offering the same course within the locality and distance to the applicant schoo
_____ Demand for the establishment of the school (enrolment in existing school, number of students
in the locality and facilities, standard and supportive provisions for effective instruction and
quality education)
_____ Availability & Adequacy of the school site
_____ Documents of Ownership
_____ Location Plan (in relation to recreational places and other factors that may not be
conducive to the learning process and far from noises/unpleasant odor and dust)
_____ Campus Development and Landscaping Plans
_____ Pictures
_____ Architect's Plan of the building
_____ Intemized cost of the project (site development, school buildings, quarters, classrooms,
equipments, facilities, library, laboratory, annual salaries, maintenance)
_____ Financial capacity to sustain and maintain school (resources besides students' fees)
_____ Bank certification in the name of the school
_____ Proposed Faculty line-up, administrative and supervisory staff with their corresponding
qualifications, transcript of records and intended salaries
______ 4.1. School Site / Documents of Ownership
_____ Copy/(ies) of Certificate of Title (TCT) No./s ___________
_____ Total lot Area / Total floor area available (Indicated) __________
( ) owned ( ) donation ( ) authority to use the school site
( ) adequate ( ) inadequate
Location ( ) same as given address, same block and lots are adjacent with each other
( ) in the name of the school
( ) in the name of the school owner / incorporator
( ) in the name of the congregation
( ) in the name of the lessor (privately owned)
( ) Lease Contract ( ) Usufruct ( ) Contract to Sell (sale on installment)
 ( ) Term of Contract _____ years

______ 4.2. School Site

____ Location Plan prepared by licensed Civil Engineer
____ Building Plan prepared by a licensed Civil Engineer
____ Development Plan
______ 4.3. Certificate of Occupancy of school building
____ sign by proper city / municipal authorities
School ____ Number of buildings and classrooms
Building ____ Structural Permit No. and date and place of inssuance
____ Sanitary Permit No. and date and place of issuance
____ Electriacal Permit and date and place of issuance
____ Mechanical Permit No. and date and place of issuance
____ Plumbing Permit No. and date and place of issuance
_______ 4.4. List of Laboratory facilities, equipment, furniture, supplies, and material classified by subject area
_____ No. of items _____Science Laboratory _____Practice House for TLE/EPP ____Industrial Arts
_______ 4.5. List of Library Holdings
_____ List of books per subject area
_____ No. of books per subject area
_____ Term of procurement/donation from other institutions
_____ Arrange according to Dewey Decimal System
_____ Category (Cultural, Fiction, Non- Fiction,Filipiniana, Professional, General References)
______ 4.6. List of Athletic Facilities, Equipment, Supplies and Materials
_____ No. of items per grade level _____ Term of procurement/donation from other institutions
______ 4.7. Original Pictures
_____ Classrooms _____ School Buildings _____ Restrooms
_____ Laboratory _____ Library _____ Medical and Dental Clinic
_____ School Canteen _____ Playground _____ School stage
_____ Flagpole _____ Principal's Office _____ Faculty Room
_____ Computer/IT/Multimedia Room _____TLE/EPP Practice House
_____ Industrial Arts Room _____ Guidance Office _____ Science Laboratory/ies
______ 4.8. Proposed Annual Budget for the School year approved by the Board of Directors
_____ Annual Salaries _____ Maintenance Expenses
_____ Capital Expenditures (Buildings, Property and Equipment)
_______4.9. Proposed Tuition and Other School Fees for New School
_____Tuition Fee _____ Miscellaneous Fees
_____ Other Fees (if any) _____ DepEd approved new rate schedule (if any)
_______ 4.10. Certification of bank deposit in the name of the school (adequate funds to support operation for
one year)
_______ 4.11. Proposed Curriculum requirements
____ Implements the Enhanced Basic Education Curriculum (K-12)
____ Class Program for the course applied for
____ Time allotment ( ) correct ( ) not correct
______ 4.12. List of Administrative Officials
4.12.1 School Head or the President, Rector, Director, or Chief Executive Officer
______ Educationally qualified ______ not qualified
( ) Filipino ( ) Master's Degree in Education or at least bachelor's degree
( ) with adequate teaching experience, managerial competence and technical
expertise in school management or background of demonstrated service in the
previous field
( ) of good moral character
( ) Full time
______ Field of Specialization
______ Certificates of Training
______ Copy of Employment Contract /Appointment
______ Copy of Transcript of Records certified true copy by the issuing institution
______ NBI and Police Clearance
______ Teaching Load, if any
4.12.2 Supervisory Officials or Principal
_____ Master's Degree in Education
_____ At least (5) years teaching experience or administrative experience
 4.12.1 Salary Rate and Benefits of Officials
( ) within the minimum rate ( ) above the minimum ( ) below the minimum

_____ 4.13. List of Academic Teaching Personnel

_____ Educationally Qualified ______not qualified
____ Pre-elementary or Kindergarten teachers should be holders of Bachelor's
degree in Early Childhood Education or Bachelor's Degree in Elementary Education
with at least 18 units of Early Childhood Education
____ Elementary School teachers should be holders of a Bachelor's Degree in Elementary
Education or its equivalent
____ Secondary School teachers should be holders of Bachelor's Degree in Secondary
Education or its equivalent
____ Teachers should be holoders of a Licensure Examination for Teachers (LET)
_____ Field of Specialization
_____ Certificates of Training
_____ Copy of Employment
_____ Copy of Transcript of Records certified true copy by the issuing institution
_____ Salaries (per hour/month) and benefits in accordance with prescribed standards
in the Labor Code
_____ Full time _____ Part time (number of teaching /working hour per week
_____ Teaching Loads
_____ Other Employment (if any)
_____ 4.14. List of Academic Non-Teaching Personnel
(registrar, librarian, school physician, school dentist, school nurse, school office staff,
guidance councelor, support staff, etc..)
_____ Educationally qualified _____ Not qualified
Registrar: Bachelor's degree and have at least (3) years of training or experience in
the serving and maintenance of the student academic records and related school
work Librarian: at least with 18 units of Library Science
_____ Transcript of Records _____ Appointment / Contract
_____ Salaries & other fringe benefits _____ Full time _____ Part time
_____ 5. Retirement Plan
_____ School initiated retirement plan registered with the BIR
_____ SSS Certificate of Registration with the name of the employees
_____ Philhealth Certificate of Registration of employees
_____ Terms of Benefits
______6. School Calendar
_____No. of School Days _____ No.of Holidays
______7. Need Demand for the establishment of the school
Existing School near the proposed school _______
Distance of proposed _______
Enrolment in the existing School _______
Number of students in the locality _______
Number of prospective students _______
______8. Student/School Manual
______9. Application and Inspection fee ( P 2,000.00)
______Total Fees Paid ______ Date of Issuance
______O.R. Number ______ Place of Issuance
______10. School Bond ( P 1,000.00)
______Bond Agreement duly accomplished and notarized
______Total Amount of Bond Posted
______Kind of Bond ( )Surety ( ) Cash ( )Real Estate

RECOMMENDATION : Date Processed: ________________

( ) FOR OCCULAR INSPECTION
 ( ) FOR ISSUANCE OF NOTICE OF DEFFICIENCY OR DISAPPROVAL

ACTION/S TAKEN :

Evaluated by : Noted by :

______________________________ RITA E. RIDDLE, CESO VI

Date: _______________________ Schools Division Superintendent
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