Commission on Higher Education

Office of Programs and Standards

Cluster A Division
Maritime Education Unit

QUALITY STANDARDS SYSTEM (QSS) Cert. No. 2001

QUALITY SYSTEM Form Title: CHED FORM: GPR 4 (MARITIME)

SUPPORT
DOCUMEN Revision No.: 1 Checked by: DQAM
TS
Page 1/3 Revision Date: September 18, 2002 Issued by: QAM

APPLICATION FOR INITIAL/RENEWAL PERMIT

_________________________________
(Course)
For the SY ______________________

__________________________
Date
The Honorable Chairman
Commission on Higher Education
DAP Bldg., San Miguel Avenue
Pasig City

Through Channels

Sir:

The undersigned Chairman of the Board of Trustees/President hereby petition for

Government Permit to operate _______________________ under the laws of the Republic
of the Philippines.

Name of School :...

Address :
Course : .

To support this petition are the following documents duly certified/authenticated:

1. Letter of application under oath. A letter of intent is not considered as an application.

2. Board Resolution on the operation of the new program certified by the Corporate Secretary;
3. Feasibility study indicating the need and the relevance of the course to the development of
the community and the resources and capabilities of the school to achieve/implement the
objective of developing the community;
4. Articles of Incorporation and By-Laws duly registered with the Securities and Exchange
Commission (SEC);
5. Copy(ies)of the Transfer Certificate(s) of Title (TCT) of the school site;
 Commission on Higher Education
Office of Programs and Standards
Cluster A Division
Maritime Education Unit

QUALITY STANDARDS SYSTEM (QSS) Cert. No. 2001

QUALITY SYSTEM Form Title: CHED FORM: GPR 4 (MARITIME)

SUPPORT
DOCUMEN Revision No.: 1 Checked by: DQAM
TS
Page 2/3 Revision Date: September 18, 2002 Issued by: QAM

6. Statement on the location of the school in revelation to recreational places gambling

establishment, bowling alleys, movie houses, markets, garbage dumps, funeral parlors,
cemeteries, jails, railroad yards, dancing halls, and manufacturing and industrial
establishment and the like. (Must be free from noise, unpleasant odor and dust, and
should be sufficiently far from the above places;
7. Campus development and landscaping plans;
8. Documents of ownership of the school buildings;
9. Certificate of Occupancy of the school building(s) from the proper city/municipal authorities;
10. Pictures of the school site and the school buildings;
11. Proposed budget/annual expenditures for the succeeding school year approved by the Board
of Trustees/Directors;
12. Proposed curriculum (For separate processing);
13. Proposed schedule of tuition and other school fees (For separate processing);
14. Copy of Retirement Plan of the school, registered with the SEC;
15. List of School Administrators, i.e. President, Vice-President(s), Deans, Department Heads,
etc., including the following (use MEU Form-IC-Administrative Profile):
a) Position/Designation;
b) Educational qualifications (where and when obtained);
c) License
d) Sea/Teaching experience
e) Trainings (IMO 6.09 and 3.12 or equivalent)
f) Status of appointments;
g) Other Benefits

16. List of teaching personnel including the following (supported with documents, use MEU
Form IA and IB for General education and professional subjects respectively)
17. List of non-teaching and non-academic personnel including the following (supported with
documents);
a) Educational qualifications (where and when obtained);
b) Field of Specialization;
c) Position/Designation;
d) Status of appointments;
e) Rate of salary per month/hour;
f) Other Benefits;
g) Outside employment, if any.

18. List of laboratory facilities, equipment, supplies and materials (use marine deck/engine
department of MEU Form 1);
19. List of athletic facilities, equipment supplies and materials;
 Commission on Higher Education
Office of Programs and Standards
Cluster A Division
Maritime Education Unit

QUALITY STANDARDS SYSTEM (QSS) Cert. No. 2001

QUALITY SYSTEM Form Title: CHED FORM: GPR 4 (MARITIME)

SUPPORT
DOCUMEN Revision No.: 1 Checked by: DQAM
TS
Page 3/3 Revision Date: September 18, 2002 Issued by: QAM

20. List of Library holdings classified into Cultural, Filipiniana, and Professional, (Professional
books are limited to the program being applied for);
21. Application and inspection fees in the amount of Four Thousand Pesos (P4,000.00) per
program must be issued in favor of the Commission on Higher Education (CHED)
22. Bond in the amount of Four Thousand Pesos (P4,000.00) per program which should not
exceed Five Thousand Pesos (P5,000.00) per school irrespective of the number of
programs. Schools which have already filed the maximum amount of Five Thousand
Pesos (P5,000.00) need not file an additional bond.
23. Quality Standard System (QSS).

I, as the Chairman of the Board/President, promise to maintain the standards required for
this course and to follow faithfully all the laws, rules and regulation and the requirements of the
Commission on Higher Education governing the operation of authorized private school course
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 of CHED shall be deemed sufficient cause for the
revocation of the authority granted.

The school will not conduct classes in the above program applied for 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

SUBSCRIBED AND SWORN TO

NOTARY PUBLIC