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PHILIPPINE NORMAL UNIVERSITY
The Countrys National Center for Teacher Education (R.A. 9647)http://www.pnu.edu.ph
CITIZENS CHARTER
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TABLE OF CONTENTS
Page
I. Vision & Mission ... 3
II. Performance Pledge 4
III. Frontline Services .. 5-47
IV. Feedback Form.. 48
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VISIONThe Philippine Normal University designated as the Countrys National Center for
Teacher Education shall be the primary source of high quality teachers and education managers
in the country and the world. As the established producer of knowledge workers in the field
of education, it shall likewise continue to inspire and shape the quality of Filipino students and
graduates.
MISSION
The Philippine Normal University is dedicated to developing teachers and educational
leaders as valued contributors in the social transformation of the Filipino for a better world.
This mission is propelled by the institutions commitments to:
1. Quality education and excellence
2. Knowledge creation and application
3. A culture of sharing and service
4. Growth, efficiency and accountability
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Performance Pledge
We, the officials, faculty and administrative employees of the Philippine Normal University, dohereby commit to the public, our clientele, a kind of service anchored on the following values and principles:
P Promptness. We ensure speedy service within reasonable time from 8:00AM to 5:00PM, Mondays toSaturdays, and when exigency of public service so demands.
N Nationalism. Imbued with Filipino values, we take pride in rendering professional service to ourfellow citizens with the prime interest of the Filipino nation in mind at all times.
U Uprightness. We live up to the highest standards of morality in the performance of our duties andresponsibilities as public servants who observe the Code of Conduct and Ethical Standards forGovernment Officials and Employees.
N Novelty. We continue to innovate in order to respond to the changing needs of our clients as weimprove the quality of our service.
C Commitment. We uphold our dedication and responsibility in pursuing our mission as an institution
of higher learning in all our endeavors and transactions with the public.
T Transparency. We maintain our business transactions at all levels open to public scrutiny andoversight as a means of fighting corruption and holding ourselves accountable to the public.
E Efficiency. We advocate competence and productiveness in dealing with our clients to achieve thedesired services without wasting time, resources and effort.
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LIST OF FRONTLINE SERVICESPAGE
A. Admissions 7-14
Center for Teaching and Learning (CTL)Undergraduate Programs
Post Baccalaureate Programs
Graduate Programs (Masters & Doctorate)
B. Enrolment 15
Freshmen
Old Students
C. Issuance of Documents 16-20
Transcript of Records
Certification
Diploma (Original/True Copy)
Evaluation
Checklist of Courses Taken
General Weighted Average (GWA)
Verification
Authentication
DFA Endorsement Completion of Grade
Withdrawal of Courses
Permit to Study
D. Student Services 21-32
Issuance of Certificate of Good Moral Character
Validation of IDs
Replacement of Lost IDs
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Leave of Absence
Dropping of Subject/s Enrolled
Exemption from Wearing Uniform
Application for Scholarships/Grants
Application for Student Assistantships Handling Complaints Against Students/Teachers
Issuance of Permit to Hold an Activity
E. Library Services 33-40
Library Card Application
Library Card Renewal/Replacement
Issuance of Permit for Outside Researcher
Borrowing/ Returning Books from Different Library Sections to Circulation Area
Library Internet Photocopying of Materials
F. Auxiliary Services 41-44
Admission of Boarders/Dormers
Accommodation of Transients
A. Reservation of University Facilities 45-47
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Title of Frontline Services : Application for Admission Test in the Graduate Programs
(Masteral and Doctoral) and Certificate in Teaching Program
(CTP)
Schedule of Availability of Service : Mondays Saturdays 8:00AM 5:00PMKey Person : Director, Office of Admissions
Who may avail of the service?
For Graduate Program
Graduate of Bachelors Degree in Education for Masteral Program
Graduate of Bachelors Degree with 18 units in CTP for Masteral
Graduate of Masters Degree for Doctoral Program
For CTP
AB/BS Graduate of Non-Education course
What are the Requirements?
1. a) Original Transcript of Records (TOR) of Bachelors degree in Education and 18 units of Education/CTP (for
Masteral)
and Masteral degree (for Doctoral).b) Original Transcript of Records of Bachelors degree (Non- Education) for CTP
2. Computed Grade Point Average (GPA) of 85% / 2.0 / B or better for Masteral/CTP and 90% / 1.75 / B+ or betterfor Doctoral
3. Certification of at least two years teaching experience (for Masteral & Doctoral)
4. Photocopy of the Marriage Contract if TOR bears maiden name5. P400 for the Admission Test fee to be paid to the University Cashier
6. Two (2) copies of 1x1 recent colored picture
Total Time Duration : 100 minutes
How to Avail of the Service:
Step Please Follow the Steps Service Provider Duration Person In chargeFee Form/
document
1Present admission requirements for
evaluation
Evaluate admission requirements of
applicant
5 minutes/applicant Director
Administrative Aid
No fee *Transcript of
Records
2 Secure Computation Form and
compute for Grade Point Average
Issue Computation Form and recheck
results of GPA if qualified
60 minutes Director
Administrative Aid
No fee Computation
Form for Grade
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(GPA) Point Average
3
If qualified, secure and accomplish
Application Form for Admission
Test
Issue Application Form and check
entries of applicants information
15 minutes Director
Administrative Aid
No fee Application
Form for
Admission Test
4Proceed to the office of theDepartment Chair for Interview and
signature / approval of application
Advice applicant to proceed to theoffice of the Department Chair and
note approval
10 minutes Department ChairAdministrative Aid
No Fee AccomplishedApplication
Form
5
Pay the Admission Test fee ofP400.00 to the University Cashiers
Office
Accept payment of Admission Testfee c/o Cashiers Office
5 minutes Cashier P400.00 Official Receiptof payment
6
Submit OR of payment and attach inthe Application Form
Encode data of applicant in theEnrollment System and print Test
Permit
3 minutes Administrative Aid No Fee Test Permit
7Claim Test Permit and sign in the
logbook
Issue Test Permit and compile
accomplished form
2 minutes Administrative Aid No fee Test Permit
Logbook
END OF TRANSCATION
Title of Frontline Services : Application for Admission Test in the Undergraduate
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(Incoming Freshmen)Schedule of Availability of Service : Mondays Saturdays 8:00AM 5:00PMKey Person : Director, Office of Admissions
Who may avail of the service? : Incoming Freshman Students / Transferees
What are the Requirements? High School Report Card (original & photocopy) -- no grade lower than 80% in all subjects in fourth year
*Transcript of Records with no grade lower than 2.0 and Honorable Dismissal (for Transferees)
Certificate of Good Moral Character from High School Principal/Guidance Counselor
Certified True Copy of Birth Certificate
Two (2) copies of 1x1 picture
P350.00 Admission Test Fee to be paid to the University Cashier
Total Time Duration: 42 minutes
How to Avail of the Service:
Step Please Follow the Steps Service Provider Duration Person In chargeFee Form/
document
1
Present admission requirements for
evaluation
Evaluate admission requirements of
applicants
5 minutes/applicant Director
Administrative Aid
No fee High School Card /
Transcript of
Records
2
Secure and accomplish Application
Form for Admission Test
Issue Application Form, check
entries of applicants information and
attach photocopy of requirements
20 minute Director
Administrative Aid
No fee Application Form
for Admission Test
3
Pay the Admission Test fee of
P350.00 to the University CashiersOffice
Accept payment of admission fee
c/o Cashiers Office
5 minutes Cashier P350.00 Official Receipt of
payment
4
Submit OR of payment and attach
with Application Form
Encode data of applicants in the
Enrollment System and print Test
Permit
10 minutes Administrative Aid No fee Test Permit
5Claim Test Permit and sign in the
logbook
Issue Test Permit and file
accomplished form
2 minutes Administrative Aid No fee Test Permit
Logbook
END OF TRANSCATION
Title of Frontline Services : Application for Admission Test in the Center for Teaching and
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Learning (CTL)Schedule of Availability of Service : Mondays Saturdays 8:00AM 5:00PMKey Person : Director, Office of Admissions
Who may avail of the service? : Incoming First Year High School Students and Kindergarten 1 Pupils (Entry
Grade Levels)What are the Requirements?
FIRST YEAR HIGH SCHOOL
1. Grade 6 Report Card no grade lower than 85 in all subjects during the third quarter of the present school year
(no grades below 80 in all subjects in all quarters/grading periods)2. Certificate of Good Moral Character from the Principal/Guidance Counselor (with school seal)
3. Certified True Copy of Birth Certificate4. Barangay Captains Certification of Residence
5. Two copies of 1x1 recent colored picture
6. P350.00. for the Entrance Examination Fee
Total Time Duration : 42 minutes
How to Avail of the Service:
Step Please Follow the Steps Service Provider Duration Person In chargeFee Form/
document
1
Present admissionrequirements for evaluation
Evaluate admissionrequirements of applicants
5minutes/applic
ant
DirectorAdministrative
Aid
No fee High SchoolCard /Transcript ofRecords
2
Secure and accomplishApplication Form forAdmission Test
Issue Application Form, checkentries of applicantsinformation and attachphotocopy of requirements
20 minute DirectorAdministrative
Aid
No fee ApplicationForm forAdmissionTest
3
Pay the Admission Test feeto the University CashiersOffice
Accept payment of admissionfeec/o Cashiers Office
5 minutes Cashier P350.00
OfficialReceipt
4
Submit OR of payment andattach with ApplicationForm
Encode data of applicants inthe Enrollment System andprint Test Permit
10 minutes AdministrativeAid
No fee Test Permit
5 Claim Test Permit and sign Issue Test Permit and file 2 minutes Administrative No fee Test Permit
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in the logbook accomplished form Aid Logbook
END OF TRANSACTION
KINDERGARTEN 11. Certified True Copy of Birth Certificate - Age 41/2 to 5 years old (Must have been born between June 2005 June 2006)
2. Barangay Captains Certification of Residence
3. Two copies of 1x1 recent colored picture4. P350.00. for the Entrance Examination Fee
Total Time Duration: 42 minutes
How to Avail of the Service:
Step Please Follow the Steps Service Provider Duration Person In chargeFee Form/
document
1
Present admissionrequirements for evaluation
Evaluate admissionrequirements of applicants
5minutes/applica
nt
DirectorAdministrativeAid
No fee AdmissionRequirements
2
Secure and accomplishApplication Form forAdmission Test
Issue Application Form,check entries of applicantsinformation and attachphotocopy of requirements
20 minute DirectorAdministrativeAid
No fee ApplicationForm forAdmissionTest
3
Pay the Admission Test feeof P350.00 to the UniversityCashiers Office
Accept payment ofadmission feec/o Cashiers Office
5 minutes Cashier P350.00
OfficialReceipt ofpayment
4
Submit OR of payment andattach with ApplicationForm
Encode data of applicants inthe Enrollment System andprint Test Permit
10 minutes AdministrativeAid
No fee Test Permit
5Claim Test Permit and signin the logbook
Issue Test Permit and fileaccomplished form
3 minutes AdministrativeAid
No fee Test PermitLogbook
END OF TRANSACTION
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Title of Frontline Services : Administration of Admission Tests
Graduate College Admission Test (GCAT) Certificate in Teaching Program (CTP) and Post Baccalaureate Specializations Admission Test
Philippine Normal University Admission Test (PNUAT)
Center for Teaching and Learning Admission Test
Schedule of Availability of Service : Sundays 8:00AM 5:00PM (Except for walk-in examination to be
scheduled)Key Person : Director, Office of Admissions
Who may avail of the service? : Qualified applicants in the Programs/LevelsWhat are the Requirements?
Test Permit with picture and official receipt of payment
Valid ID of examineeTime Duration of Examination: 2 hours
Test Results Release: 10 working days after the scheduled testTotal Time Duration: 2 hours and 40 minutes
How to Avail of the Service:
Step Please Follow the Steps Service Provider Duration Person In chargeFee Form/
document
1
Locate examinees name on the
master list posted and present Test
Permit with ID to the Proctor
Check Test Permit and valid ID for
verification and orient examinees
30 minutes /
examinee
Director
Proctor
No fee Test Permit
Valid ID
Lists ofExaminees
2Take the Admission Test Administer Admission Test as
scheduled
2 hours Proctor No fee Test Booklet
Answer Sheet
3Return test materials to the Proctorafter the test
Retrieve test materials andcountersign Test Permit
5 minutes Proctor No fee Test BookletAnswer Sheet
4Get schedule of release of test results
(10 working days after the test)
Release test result and inform
schedule of Enrollment
5 minutes Director
Administrative Aid
No fee Admission
Test Results
END OF TRANSACTION
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Title of Frontline Services : Interview Procedure for Incoming Freshmen Undergraduate
CTL First Year High School and Kindergarten 1
Schedule of Availability of Service : To be scheduled 10 days after the release of test 8:00AM 5:00PM
Key Person : Director, Office of Admissions
Who may avail of the service? : Passers in the PNU Admission Test (Incoming Freshman Students/Transferees)What are the Requirements for Interview?
Fourth Year High School Report Card*Transcript of Records and Honorable Dismissal (for Transferees)
Certificate of Good Moral Character from High School Principal/Guidance Counselor
School ID
Interview Sheet to be accomplished by the applicant
Test Permit
Total Time Duration: 2 hours and 55 minutes
How to Avail of the Service:
Step Please Follow the Steps Service Provider Duration Person In chargeFee Form/
document
1
Present interviewrequirements for verification
Verify Interview requirementsof applicant
5 minutes /interviewee
DirectorAdministrativeAid
Nofee
Interviewrequirements
2
Secure and accomplishInterview Form
Issue Interview Form, callnumber
and check entries
15 minutes AdministrativeAid
StudentAssistant
Nofee
InterviewSheet
Call number
3
When number is called,present all requirements tothe Interviewer
Interview applicant 10 minutes Interviewer Nofee
AccomplishedInterviewform andrequirements
4 If passed the Interview,receive Recom mendationfor Medical. If not, get allrequirements except
Issue Recommendation forMedical, for passers.Return all requirements fornon-passers
5 minutes Interviewer Nofee
Recommendation forMedical
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Interview Form
5
Proceed to Medical Clinic forphysical and dentalexaminations
Conduct physical examinationc/o Medical & DentalPersonnel
2 hours c/o Medical &DentalPersonnel
c/oMedical
Medical &DentalRecord
6Claim and submit MedicalClearance after 5 workingdays
Receive and record submittedMedical Clearance
15 minutes DirectorAdministrativeAid
Medical andDentalClearance
7
Get Confirmation Form forEnrollment
Release Confirmation Formfor Enrollment
5 minutes DirectorAdministrativeAid
ConfirmationForm
END OF TRANSACTION
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Title of Frontline Services : Pre-Enrollment Procedure (Incoming Freshmen)Schedule of Availability of Service : Mondays Saturdays 8:00AM 5:00PMKey Person : Director, Office of Admissions
Who may avail of the service? : Qualifiers in the Interview (Incoming Freshman Students / Transferees)
What are the Requirements for Pre-Enrollment? Original Fourth Year High School Report Card
*Original Transcript of Records and Honorable Dismissal (for Transferees)
Certificate of Good Moral Character from High School Principal/Guidance Counselor
Certified True Copy of Birth CertificateTotal Time Duration : 1 hour
How to Avail of the Service:
Step Please Follow the Steps Service Provider Duration Person In chargeFee Form/
document
1Get call number and Pre-EnrollmentForm to be accomplished Issue call number and Pre-EnrollmentForm 10 minutes/enrollee DirectorAdministrative Aid No fee Call numberPre-
Enrollment
Form
2
Submit Enrollment requirements for
verification and call number
Verify entry requirements of student
and encode in the Enrollment System
10 minutes Director
Administrative Aid
No fee Entry
requirements
3
Claim Notice of Admission for
Enrollment
Issue automated Notice of Admission
and designated section of student
7 minutes Director
Administrative Aid
No fee Notice of
Admission
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4
Log in to the List of Students by
section
Record list of students for
consolidation
3 minutes Administrative Aid
Student Assistant
No fee List of
Students by
section
5
Submit Notice of Admission on the
day of the Enrollment
Enroll students in the Enrollment
System c/o Office of the Registrar
30 minutes c/o Office of the
Registrar
First Year Adviser
Notice of
Admission
Master List of
Students
Title of Frontline Services : Accepting Application & Issuance of the following Documents:
1. Transcript of Records
Graduate (G)
Post-Baccalaureate
Undergraduate (UG)
Undergraduate Specialization
2. Certification
Completion of Academic Requirements (CAR)
Detailed Description of Courses
English as the Medium of Instruction
Enrolment
Exemption from Special Order of Graduation (S.O.)
General Weighted Average (GWA)
Grades
Graduation
Units earned3. Diploma (Original/Duplicate)
English Translation
Evaluation of Grades (Graduate Level)
4. Checklist (Undergraduate Level)
5. Completion of Grades6. Certified True Copy of Entrance Data
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7. Honorable Dismissal/Transfer Credential8. Permit to Study
9. Withdrawal of Courses
10. CAV (Certification, Authentication and Verification of Documents)11. DFA Endorsement
Duration: Undergraduate Transcript of Records MIS (Available on the Database) - 10 working days (Year 2000 onwards)*Undergraduate Transcript of Records - Old (For re-encoding and rechecking) - 15 working days (Year 1999
downwards)*Graduate Level Transcript of Records-- 15 working days*
Post-Baccalaureate/Undergraduate Specialization Transcript of Records 10 working days*
*If second request 5 working daysCertification 10 working days
*Detailed Description of Courses 15 working daysChecklist 5 working days
Evaluation of Grades (Graduate Level) - 15 working days
Study Permit 5 working daysDuplicate Diploma 15 working days
Authentication 2 working daysHonorable Dismissal/Transfer Credential 1 working day
Schedule of Availability of Service: Mondays through Fridays 7:00 am - 5:00 pm ; Saturdays - 8:00 am 5:00 pm
Who may avail of the service:
Graduate and Undergraduate Students, Alumni, Foreign Students, Schools, Companies, Foreign and Local Evaluators
What are the requirements?
Affidavit of Loss for Securing Duplicate Diploma
Affidavit for Correction of Name / Birthday Original (to be returned)/ Photocopy of Marriage Contract for Married Students
Documentary Stamps (for TOR and Diploma)
Permit to Study from the Division Office concerned
Total Time Duration: 70 minutes
How to Avail of the Service:
Step Please Follow the Steps Service Provider Duration Person In chargeFee Form/
document
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1Secure and fill-out Application
Form for Document/s
Issues and checks Application Form
for Document/s10 minutes
Information Desk
ClerkNone
Application
for
Document/s
2 Pay at the Cashiers OfficeAccepts payment for document/s
requested10 minutes Cashier
Depends on
the kind of
Document
(Refer to
the
Schedule ofFees from
the
Accounting
Office)
Official
Receipt
Applicationfor
Document/s
3
Proceed to the Accounting Office
for General Clearance, if applicable.A general Clearance is required if
the application is filed for the first
time, particularly the TOR, Diploma
and the Evaluation of Grades in the
Graduate Level. If not applicable,
proceed to Step 4
Issues General Clearance Form 30 minutes
Accounting Staff,
Library Staff, and
Office of Student
Affairs Staff
None
General
Clearance
Form
4File the Application Form atWindow 5, Office of the University
Registrar and secure Claim Stub
Checks entries in the Application
Form, making sure that the O.R. and
the General Clearance Form duly
signed by all authorities concerned
are attached and that documentarystamps are provided for TOR and
Diploma applications
20 minutes Registrar Staff None
Application
for
Document/swith General
Clearance
Form andO.R.
Claim Stub
END OF TRANSACTION
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Title of Frontline Services : Releasing of the following documents:
1. Transcript of Records2. Graduate (G)
Post-Baccalaureate
Undergraduate (UG)
Undergraduate Specialization
3. Certification
Completion of Academic Requirements (CAR)
Detailed Description of Courses
English as the Medium of Instruction
Enrolment
Exemption from Special Order of Graduation (S.O.)
General Weighted Average (GWA)
Grades Graduation
Units earned
4. Diploma (Original/Duplicate)
English Translation5. Evaluation of Grades (Graduate Level)
6. Checklist (Undergraduate Level)
7. Completion of Grades8. Certified True Copy of Entrance Data
9. Honorable Dismissal/Transfer Credential
10. Permit to Study11. Withdrawal of Courses12. CAV (Certification, Authentication and Verification of Documents)
13. DFA Endorsement
Duration: Undergraduate Transcript of Records MIS (Available on the Database) - 10 working days (Year 2000 onwards)*Undergraduate Transcript of Records -- Old (For re-encoding and rechecking) - 15 working days (Year 1999
downwards)*Graduate Level Transcript of Records-- 15 working days*
Post-Baccalaureate/Undergraduate Specialization Transcript of Records 10 working days*
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*If second request 5 working daysCertification 10 working days
Detailed Description of Courses 15 working daysChecklist 5 working days
Evaluation of Grades (Graduate Level) - 15 working daysStudy Permit 5 working daysDuplicate Diploma 15 working days
Authentication 2 working daysHonorable Dismissal/Transfer Credential 1 working day
Schedule of Availability of Service:Mondays through Fridays 7:00 am - 5:00 pm ; Saturdays - 8:00 am 5:00 pm
Who may avail of the service:
Graduate and Undergraduate Students, Alumni, Foreign Students, Schools, Companies, Foreign and Local
Evaluators who filed an Application for DocumentWhat are the requirements? Claim Stub
Total Time Duration: 10 minutes
How to Avail of the Service:
Step Please Follow the Steps Service Provider DurationPerson In
charge
Fee Form/
document
1
Present Claim Stub at Window 5,Office of the University Registraron the scheduled date of release
Releases the document/s beingrequestedAsks the applicant to sign on theLogbook
10 minutes Registrar Staff NoneClaim StubDocument/sapplied for
2 END OF TRANSACTION
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Title of Frontline Service : Validation of IDsSchedule of Availability : Monday Friday, 8:00 a.m. - 5:00 p.m.
Key Person : Dean, Office of Student Affairs and Student Services
Who May Avail of the Service : StudentsWhat are the Requirements :
ID
Registration Form
Duration : 2 hoursFee Charged : None
How to Avail of the Service:
Step Please Follow the Steps Service Provider DurationPerson In
charge
Fee Form/
document
1
Present ID together with Registration
Card and sign on the Logbook
Receives ID and Registration Card
for validation of enrolment 1 hour OSASS Secretary Logbook
2 Signs the ID 30 mins. OSASS Dean
3Claim the validated ID and sign on
the Logbook30 mins. OSASS Secretary Logbook
END OF TRANSACTION
Title of Frontline Service : Issuance of Affidavit for Lost ID
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Schedule of Availability : Monday Friday, 8:00 a.m. - 5:00 p.m.Key Person : Dean, Office of Student Affairs and Student Services
Who May Avail of the Service : Students
What are the Requirements :
Affidavit of Loss
Duration : 3 hoursFee Charged : P50.00
How to Avail of the Service:
Step Please Follow the Steps Service Provider DurationPerson In
charge
Fee Form/
document
1Present to OSASS letter explaininghow ID got lost
Evaluates the letter 1 hour OSASS Dean
2
Secure a duly notarized Affidavit of
Loss from the City Hall and present
it to the OSASS
Files Affidavit of Loss 1 hour OSASS SecretaryAffidavit of
Loss
3Secure and accomplish TemporaryPass Slip and Request for New ID
Gives Logbook to requesting party
for documentation of his/her
transaction
30 mins. OSASS SecretaryTemporary
Pass Slip
4Present Request for New ID to
University Press for processing
Receives Request for New ID and
asks requesting party to pay at the
Cashiers Office and present Official
Receipt before accomplishingPersonal Information Slip and
having his/her picture taken
1 hourUniversity Press
Director/Staff
Personal
Information
Slip
END OF TRANSACTION
Title of Frontline Service : Filing ofLeave of AbsenceSchedule of Availability : Monday Friday, 8:00 a.m. - 5:00 p.m.
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Key Person : Dean, Office of Student Affairs and Student ServicesWho May Avail of the Service : Students
What are the Requirements :
Leave of Absence Form
Duration : 3 hours
Fee Charged : NoneHow to Avail of the Service:
Step Please Follow the Steps Service Provider DurationPerson In
charge
Fee Form/
document
1
Consult the Guidance Counselor and
request for and accomplish a Leave
of Absence (LOA) Form in triplicate
Confers with the student about
his/her desire to go on leave1 hour OSASS Counselor
Leave of
Absence
Form
2Receives the accomplished Leave of
Absence (LOA) Form and signs it30 mins. OSASS Dean
Leave of
Absence
Form
3 Claim the signed LOA Form Returns signed LOA Form to student 30 mins.OSASS
Secretary/Staff
Leave of
Absence
Form
4Submit the signed LOA Form to the
Registrar Office
Receives the signed LOA Form for
approval of the Registrar30 mins.
Registrar Office
Staff
Leave of
Absence
Form
Claim his/her copy and give another
copy to OSASSReceives OSASS Copy 30 mins.
OSASS
Secretary/Staff
Leave of
Absence
Form
END OF TRANSACTION
Title of Frontline Service : Dropping of SubjectsSchedule of Availability : Monday Friday, 8:00 a.m. - 5:00 p.m.Key Person : Dean, Office of Student Affairs and Student Services
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Who May Avail of the Service : StudentsWhat are the Requirements :
Dropping FormDuration : 1 days
Fee Charged : None
How to Avail of the Service:
Step Please Follow the Steps Service Provider DurationPerson In
charge
Fee Form/
document
1
Consult the Guidance Counselor and
request for and accomplish Request
to Drop Undergraduate Courses
Form in triplicate
Confers with the student about
his/her desire to drop his/her courses1 hour OSASS Counselor
Dropping
Form
2
Secure signature of professors for
official dropping of courses and
submit copies of the signed
Dropping Form in triplicate to the
OSASS for the signature of the
Guidance Counselor and the Dean
before submitting them to the
Registrars Office
Receives the accomplished Dropping
Form duly signed by the professors
concerned for approval of the
Registrar
1 day
OSASS
Counselor/Dean
Registrar Office
Staff
Dropping
Form
3Returns two copies to student: one
for him/her, one for OSASS
Registrar Office
Staff
Dropping
Form
4Claim his/her copy and submit
another copy to OSASSReceives OSASS Copy 1 hour
OSASS
Secretary/Staff
Dropping
Form
END OF TRANSACTION
Title of Frontline Service : Request for Exemption from Wearing the School UniformSchedule of Availability : Monday Friday, 8:00 a.m. - 5:00 p.m.Key Person : Dean, Office of Student Affairs and Student Services
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Who May Avail of the Service : StudentsWhat are the Requirements :
ID
Excuse Letter
Duration : 1 hourFee Charged : NoneHow to Avail of the Service:
Step Please Follow the Steps Service Provider DurationPerson In
charge
Fee Form/
document
1Submit request letter on non-wearing
of school uniform
Evaluates excuse letter and issues
Exemption Slip1 hour OSASS Secretary
Exemption
Slip
2Show exemption slip
to teacher/security guard
Teacher/guard examines authenticity
of Exemption SlipTeacher/Guard
Exemption
Slip
END OF TRANSACTION
Title of Frontline Service : Processing of Application for Scholarships/Grants
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Schedule of Availability : Monday Friday, 8:00 a.m. 5:00 p.m.Key Person : Scholarship Coordinator of OSASS
Who May Avail of the Service : Scholars/Grantees
What are the Requirements :
GWA
Autobiography
ITR
Certificate of Indigency
Personal Data Sheet
Sketch of Residence
Duration : 7 working days
Fee/Charge : None
How to Avail of the Service
Step Please Follow the Steps Service Provider Duration Person Incharge
Fee Form/document
1Submit requirements Evaluates completeness of documents 1 day Scholarship
Coordinator
Personal Data
Sheet
2
Recommends qualified applicants to
donors
Submits list of chosen scholars to
OSASS for the OSASS Deans
approval
1 dayScholarship
Coordinator/
OSASS Dean
3
Await posting of names of scholars
at OSASS Bulletin Board
Informs who were chosen as
recipients of scholarships
2 working days Scholarship
Coordinator/OSASS Secretary
4
Inquire at the Cashiers Officeif stipends are available orhave been released
Prepares request for SpecialOrder of payment of stipend
3 working daysOSASS
Secretary
END OF TRANSACTION
Title of Frontline Service : Processing of Application for Student Assistantships
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Schedule of Availability : Monday Friday, 8:00 a.m. - 5:00 p.m.Key Person : Dean, Office of Student Affairs and Student Services
Who May Avail of the Service : Students
What are the Requirements :
Student Application Form
Copy of grades
Registration Form
Duration : 3 daysFee Charged : None
How to Avail of the Service:
Step Please Follow the Steps Service Provider DurationPerson In
charge
Fee Form/
document
1Secure and accomplish ApplicationForm for Student Assistantship at
OSASS
Issues an Application Form forStudent Assistantship to student
applicant
1 hourOSASS
Secretary/Staff
Application
Form for
StudentAssistantship
2Undergo interview with Head ofOffice/Department where student is
applying as Student Assistant
Receives recommendation form from
Department/Office Head1 day
OSASS
Secretary/Staff
Application
Form for
Student
Assistantship
3Determines if applicant meets allqualifications and signs on the
application form
1 day
OSASS Dean
Application
Form for
StudentAssistantship
4Await posting of list of successfulapplicants
Prepares a list of successful
applicants and submits it to theUniversity President through theHRMO for his approval
1 day
OSASS
Secretary/Staff
List of
StudentAssistants
5Wait for Special Order issued by the
HRMOPrepares Special Order
HRMO Head/Staff
END OF TRANSACTION
Title of Frontline Service : Handling of Complaints Against Students/FacultySchedule of Availability : Monday Friday, 8:00 a.m. - 5:00 p.m.Key Person : Dean, Office of Student Affairs and Student Services
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Who May Avail of the Service : Anyone aggrieved or offended by a student/faculty memberWhat are the Requirements :
Accomplished Incident Report Form also referred to as complaint form;
Full name of the student/teacher complained about & full name of person complaining;
A narration of relevant facts that show the offense allegedly committed by the student/facultymember complained about;
Evidence and testimonies of witnessesDuration : 1 working days
How to Avail of the Service:
Step Please Follow the Steps Service Provider DurationPerson In
charge
Fee Form/
document
1Orally report complaint to the Office
of Student Affairs & Services
Discusses complaint with
complainant and gives Logbook to
document complaint
1 hour Counselor/s Logbook
2 Accomplish & submit IncidentReport Form
Receives accomplished IncidentReport Form
1 hour Counselor/s IncidentReport Form
3
Confirm venue, date & time of fact-
finding dialogue/hearing to be
conducted
Attend conduct of dialogue/ hearing
Informs complainant on venue, date
and time of dialogue/hearing
Conducts dialogue/hearing and
works for resolution of case
1 hour
1 day
Counselor/s
OSASS Dean
Notice of
Dialogue/
Hearing
Logbook
END OF TRANSACTION
Title of Frontline Service : Issuance of Permit to Hold an ActivitySchedule of Availability : Monday Friday, 8:00 a.m. - 5:00 p.m.
Key Person : Dean, Office of Student Affairs and Student Services
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Who May Avail of the Service : StudentsWhat are the Requirements :
Permit to Hold an Activity FormDuration : 2 hours
Fee Charged : None
How to Avail of the Service:
Step Please Follow the Steps Service Provider DurationPerson In
charge
Fee Form/
document
1
Secure and accomplish Permit to
Hold an Activity Form and attach
project/program proposal
Receives accomplished form and
reads entries therein.1 hour
OSASS
Secretary/Staff
Permit to Hold
an Activity
Form
2 Affixes signature on the form 30 mins.
OSASS Dean
Permit to Hold
an Activity
Form
3 Return signed form to student 30 mins.
OSASS Secretary
Permit to Holdan Activity
Form
4Get signed form and submit it to theOffice of the VP for Administration,
Finance and Development
Receives form signed by OSASS VP for AFD Staff Permit to Hold
an Activity
Form
5 Claim signed form Signs on the formVP for AFD
Permit to Hold
an ActivityForm
END OF TRANSACTION
Title of Frontline Service : Dental Checkup & TreatmentSchedule of Availability of Service : Monday Saturdays, 8:00am-5:00pm
Who may avail of the service : students
What are the requirements:Students ID
Duration:
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How to avail of the service?
Step Please Follow the Steps Service Provider Duration Person In chargeFee Form/
document
1Present ID, explains purpose,
Undergo interview
Verifies identity and dental treatment
needs of patient. 10 minutesDental Aide
DentistDental Form
2Accomplish dental service
form (DSF)
Evaluates the entries in the dental
service
form.2 minutes Dentist Dental Form
3Undergo oral-dental examination and
/or treatment
Conducts oral-dental examinationand/ or
treatment
10-30 minutes
*or longerDentist
4 *Secure prescription of medicine Gives Advise on proper care and/orprescribes medicine, if necessary
5 minutes Dentist Prescription
5 *Claims referral to Specialist Refers patients with special cases Dentist Prescription
END OF TRANSACTION
*depending on case
Title of Frontline Services Medical Checkup and TreatmentSchedule of Availability of Service: Monday Friday, 8:00am-5:00pm ; Saturday 8am-12 noon
Who may avail of the service : students
What are the requirements:
Enrollment printout (for new students);
ID (for old students)Duration : 30-40 minutes
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How to avail of the service?
Step Please Follow the Steps Service Provider Duration Person In chargeFee Form/
document
1
For Physical Exam
Go to clinic, present enrollment
printout, signs physical examinationlog book
Inspects validity of presented
document/ID2-3 minutes Registered Nurse
2Accomplishes medical
information sheet (MIS)
Guides patient in accomplishing MIS5-10 minutes
Registered Nurse
3
Undergo measurement of height,
weight, BP, respiration, pulse rate,
visual acuity & pertinent past and
present medical history taken
Conducts accurate measurements10-15 minutes
Registered Nurse
4 Secure X-Ray referral Issues X-Ray request form 1 minute Registered Nurse
5Submits to physical examination Conducts physical examination
10-15 minutes Physician
1
For Medical Consultation
Go to clinic, present ID & present
chief complaint
2 Have vital signs taken
3Submits to physical examination Conducts physical examination
10-15 minutes Physician
END OF TRANSACTION
LIBRARY SERVICES
Title of Frontline Services : New Library Card ApplicationSchedule of Availability of Service : First Three Months of the Semester (Monday-Saturday 8:00-12:00; 1:00-5:00)
Key Person : Librarian/ Library Staff In-charge of the Circulation SectionWho may avail of the service? Bonafide New Students, Faculty and Staff
What are the Requirements?
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New StudentsValidated University ID
Current Registration Form
1 x 1 I.D. PictureFaculty and Staff
University IDx 1 ID Picture
Duration:
Fees/Charges : NONE
How to avail of the service?
Step Please Follow the Steps Service Provider Duration Person In chargeFee Form/
document
1
Present requirements Evaluates requirements of applicants 3 minutes Library Staff Validated
University IDCurrent
Registration
Form
1 x 1 I.D.
Picture
2
Secure Library Membership Form Issues Library Membership Form to
new applicant
1min/ client Library Staff Library
Membership
Form/ Library
Card
3
Accomplish Library Membership
Form/ Library Card
Checks entries of applicants
information
10 minutes Library Staff Library
Membership
Form/ Library
Card
4Validation of Library Card Stamps Students Registration Form
and Date of Application
5 minutes Librarian Registration
Form and
Library Card
5Registers applicants name in the
library database
Encodes data of applicant in the
Library Software Program
10 minutes Library Staff Library
Membership
Form
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6Claim Validated Library Card for the
Current Term
Releases Validated Library Card 5 minutes Librarian Validated
Library Card
END OF TRANSACTION
Title of Frontline Services : Library Card Application for Renewal / ReplacementSchedule of Availability of Service : First Three Months of the Semester (Monday-Saturday 8:00-12:00; 1:00-5:00)Key Person : Librarian/ Library Staff In-charge of the Circulation Section
Who may avail of the service? : Bonafide New Students, Faculty and Staff
What are the Requirements?
Validated University IDCurrent Registration Form
Old Library Card for Renewal /*Application Letter of Lost Library CardDuration:
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Fees/Charges: NONE
How to avail of the service?
Step Please Follow the Steps Service Provider Duration Person In chargeFee Form/
document
1
Presents requirements Evaluates requirements of applicants 3 minutes Library Staff -Validated
University ID
-CurrentRegistration
Form
*Application
Letter of Lost
library Card
2*Secure Library Card
(for Lost Card Only)
Issues Library Membership Form to
new applicant
1min/ client Library Staff Accomplished
Library Card
3 Validate Library Card Stamps Students Registration Formand Date of Application 5 minutes Librarian RegistrationForm and
Library Card
4
Registers applicants name in thelibrary database
Encodes data of applicant in theLibrary Software Program
10 minutes Library Staff AccomplishedLibrary
Membership
Form
5Claim the Validated Library Card forthe Current Term
Releases Validated Library Card 5 minutes Librarian ValidatedLibrary Card
END OF TRANSACTION
Title of Frontline Services : Visitor Permit of Outside ResearcherSchedule of Availability of Service : Monday-Friday 8:00-5:00Key Person : Library Staff In-charge at the Circulation Section and Librarians of Readers
Services Sections
Who may avail of the service? Outside ResearcherWhat are the Requirements?
Referral Letter
Validated IDDuration:
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Fee/ Charges : P 100.00 per day per visit (Exclusive for SMI-IC Members)
How to avail of the service?
Step Please Follow the Steps Service Provider Duration Person In charge
Fee Form/
document
1
Present requirements Evaluates requirements ofapplicants
3 minutes Library Staff ReferralLetter
2Secure Order of Payment Issues Order of Payment 5 minutes Librarian Order of
Payment
3Pay to the University CashiersOffice
Accepts payment of outsideresearchers fee
5 minutes Cashier Receipt of Payment
4
Submit Original Receipt of
payment
Stamps OR and records the OR
number to the record bookAccomplishes Visitor Permit
5 minutes Librarian Visitors
Permit
5Claim Visitors Permit Issues Visitor Permit and files the
referral letter5 minutes Librarian Visitors
Permit
6
Present Visitors Permit toDesignated Reading Area
Assists outside user to the readingarea
One day Librarian In-chargeof the Reading
Area
Visitor Permit/ Validated ID
END OF TRANSACTION
Title of Frontline Services : Borrowing/ Returning Books from Different Library Section
to Circulation AreaSchedule of Availability of Service : Monday-Friday 4:30-6:30 PM; Saturday 3:00-4:30 PM
Key Person : Librarian of Each Section and Circulation In-chargeWho may avail of the service? : Faculty/ Staff and Students
What are the Requirements?
Validated ID
Borrowers Library Card
Duration:
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Fees/ Charges:P 2.00 per day for non-reserve overdue books
P 5.00 per day for reserve overdue books
(Exclusive on Saturday, Sundays and Holidays)
How to avail of the service?
Step Please Follow the Steps Service Provider Duration Person In chargeFee Form/
document
1
Presents requirements Evaluates requirements ofapplicants
3 minutes Library Staff BorrowersLibrary Card
2
Registers in the library sectionlogbook
Accommodates clients 5 minutes Librarian of EachSection
Logbook
3
Gets library materials to beborrowed for photocopying/classroom use/ overnight loan
Facilitates the retrieval of librarymaterials
15 minutes Librarian of EachSection
LibraryBorrowersCardBook Card
4
Accomplishes the neededinformation found in the book card
Issues book for overnight loanwith respected control card forthe Circulation Section transaction
5 minutes Librarian of EachSection
Pass Card
5
Proceeds to the CirculationSection for charging out anddeactivation of books
Encodes the transaction in thelibrary software
5 minutes Library Staff ofCirculation Section
ValidatedUniversity ID
6Claims book borrowed forovernight loan
Issues loan receipt to client 5 minutes Library Staff ofCirculation Section
Loan Receipt
7
Returns the use book for re-activation
Activates books returnEntered loan book in the database if overdue see belowprocesses
5 minutes Library Staff ofCirculation Section
Loan ReceiptLibraryBorrowersCard
8 Pays overdue fee to the librarianif less thanP 30.00
Records amount paid in thelogbook to be forwarded to theUniversity Cashier at the end of
5 minutes Library Staff ofCirculation Section
Loan ReceiptLogbook
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the week
9Receives order of payment ifmore than P 30.00
Bills payment 5 minutes Library Staff of Circulation Section
Order ofPayment
10Pays the amount to Cashier Accepts payment for overdue
books15 minutes Cashier Official
Receipt
11
Presents OR to the Librarian forthe Issuance of Library Card
Records OR number to logbookand Issued ones BorrowersLibrary Card
15 minutes Library Staff ofCirculation Section
LibraryBorrowersCard
12
Claims Borrowers Library Card Releases ones Borrowers LibraryCard
5 minutes Library Staff ofCirculation Section
LibraryBorrowersCard
END OF TRANSACTION
Title of Frontline Services : Library Internet is for surfing and gathering of information for
research purposes and for e-mailing. Use of facilities for
internet games and for encoding term papers, reports and other
similar materials are not allowed.Schedule of Availability of Service : Mondays Fridays, 8:00AM 6:00PMKey Person :Who may avail of the service? : Bonafide Students; Faculty; Administrative Staff
What are the Requirements:Students ID duly validated for the current semester
Duration:
Fees/Charges:
Internet: P15.00/hour
Printing: P 3.00/page
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How to avail of the service?
Step Please Follow the Steps Service Provider Duration Person In chargeFee Form/
document
1Inquire about ComputerAvailability
2 Register in the Logbook
3 Proceed to computer Area
4 Payment of Fees
5
6
7
END OF TRANSACTION
Title of Frontline Services : Photocopying of Materials. The PNU does not allow materials
in the _____________ Section to be brought home. They may,
however, be photocopied upon request. The library does not have
photocopying equipment. The client will have to
Schedule of Availability of Service : Mondays Fridays, 8:00AM 6:00PM ; Saturdays 8:00 AM - 5:00 PMContact Person:Who may avail of the service?
What are the Requirements:
Library ID CardPhotocopying Pass
How to avail of the service?
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Step Please Follow the Steps Service Provider Duration Person In chargeFee Form/
document
1 Fill-up Book Card
2 Request for Photocopying Pass
3 Photocopying of Materials
4 Claim Photocopying Pass
5 Checking of Book
6 Claim Library ID Card
7
END OF TRANSACTION
NORMAL HALL AND CONVENTION CENTER SERVICES
Title of Frontline Services : Admission of Student Dormers (Undergraduate)Schedule of Availability of Service : Mondays Saturday, 8:00AM to 5:00PM (enrollment period per semester)
Contact Person : Dormitory Manager, Office of the Auxiliary Services
Who may avail of the service? : Regular Students of the Philippine Normal UniversityWhat are the Requirements:
Current Registration FormTwo copies of 1x1 recent picture
Current Official Receipt
Duration : 1 hour & 20 minutesFees/Charges : P900.00 / month
How to avail of the service?
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Step Please Follow the Steps Service Provider Duration Person In chargeFee Form/
document
1Present current registration formfor verification
Verifies the registration form ofthe student
3 minutes Staff on duty
2Secure application form for
admission at the dormitoryIssues application form 2 minutes Staff on duty
3 Accomplish the application formChecks entrees of applicants
information10 minutes
Staff on duty
4 Take the interview Conducts interview 15 minutes Staff on duty
5Sign contract together with
parent/guardianIssues contract to the qualified student 20 minutes Staff on duty
6 Secure order of paymentIssues order of payment (2mos
advance & 1 mo deposit)2 minutes
Staff on duty
7 Pay fees Accepts payments 5 minutes Staff on duty
8 Present Official ReceiptRecords the official receipt to
individual Ledger Card3 minutes
Staff on duty
9 Present current ID picturesPastes on the individual records
(ID Card & permission Card)5 minutes
Staff on duty
10 Secure room assignment Gives room assignment 10 minutes Staff on duty
11Proceed to the assigned
room/bed
Assists the dormers going to the
assigned room15 minutes
Staff on duty
END OF TRANSACTION
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Title of Frontline Services : Accommodation of Transient/s
Schedule of Availability of Service : Mondays Saturday, 8:00AM to 5:00PM (enrollment period per semester)Contact Person : Dormitory Manager, Office of the Auxiliary Services
Who may avail of the service? : Transient/s or Customer/s from local and international sectorsWhat are the Requirements:
ID/PassportDuration : 77 minutes
Fees/Charges:
P600/head ( aircon)P450/head (non-aircon)
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How to avail of the service?
Step Please Follow the Steps Service Provider Duration Person In chargeFee Form/
document
1Make phone call or personalinquiry
Handles queries of client/sRecords messages
10 minutes/client
Staff on dutyLogbook forreservation
2 Register at the front desk
Asks the ID of the client for verification
Assists the client in filling up the formsIssues the key for the assigned room
Guides the client to the assigned room
5 minutes/
client
5 minutes/client
5 minutes10 minutes
Staff on dutyTransients
Registry Logbook
3*
Report the problem/s observed in
the rooms, if any
Checks the rooms to determine problem/s
Calls and asks the concerned staff to settle theproblem/s
20 minutes
30 minutes Staff on duty
4Inform the staff on duty thathe/she is checking out
Computes the payable amountIssues billing statement
15 minutes Staff on dutyLogbookBilling
Statement
5 Give payment to the staff on duty Receives payment 2 minutes Staff on duty
P600/headaircon
P450/headnon-aircon
6 Claim official receipt
Issues official receipt, records & remits
to the University Cashier 5 minutes Staff on duty
Official
Receipt
7Log out and leave at thehostel
Assists the client in logging out15 minutes Staff on duty
Logbook
Claim gate pass Issues gate pass 5 minutes Staff on duty Gate Pass
END OF TRANSACTION
*
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Title of Frontline Services : Use of FacilitiesSchedule of Availability of Service : Mondays Fridays; 8:00 AM 5:00 P.M.
Key Person : Executive Assistant II
Who may avail of the service? : Faculty, Staff, students, Outside Organizations
What are the Requirements for the use of facilities? For Students
Department Based Organizations :
o Activity Form signed by the Adviser, Department Head, College Dean, OSASS Dean
o Form for use of facilities signed by the Adviser, Department Head, College Dean,
OSASS Dean, VPAFD
Interest Clubs:
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o Activity Form signed by the Adviser, Student Government, Coordinator of Student
Activities, OSASS Dean
o Form for use of facilities signed by signed by the Adviser, Department Head, College
Dean, OSASS Dean, VPAFD
For Faculty
o Form for use of facilities signed by the Department Head, College Dean, VPPRE/VPA (if
applicable), VPAFD
For Employees
o Form for use of facilities signed by the Department Head, Divisions Director, VPAFD
Outside Organizations
Letter of Request for use of facilities addressed to the University President
Approved letter of request will be forwarded to the PPCD for physical arrangements/items needed and
to the Security Office
Order of Payment to be issued by the Accounting Office
Copy of Official Receipt for recording at VPAFDFees Charges:
AV Theater P10,000
Main Auditorium P10,000
HRD Auditorium P10,000
Maceda Auditorium P 7,000
Library Conference Room P 4,000
Alumni & Public Relations Hall P 10,000
Classroom P 1,500
How to avail of the service?
For Faculty/Staff/Students
Step Please Follow the Steps Service Provider Duration Person In chargeFee Form/
document
1
*Present approved activity form Check the authorized signatory
of the activity form
5 minutes Executive
Assistant
*Present
approved
activity form
2 Secure and fill-out Form for the Issues form for use of facilities 2 working days Executive Secure and
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Use of Facilities Assistant fill-out Form
for the Use ofFacilities
3
Submit accomplished Form for
use of facilities
Check the authorized signatory
of the form for use of facilities
10 minutes Executive
Assistant
Submit
accomplishedForm for use
of facilities
END OF TRANSACTION
*Not applicable for Faculty/Staff Activities
For Outside Organizations
Step Please Follow the Steps Service Provider Duration Person In chargeFee Form/
document
1
Letter of Request for use of
facilities addressed to theUniversity President
Letter of request to be forwarded
to the Office of the President
2 working days VPAFD
Office of thePresident
Letter
request foruse of
facilities
2
Approved letter of request Approved Letter of Request willbe forwarded to the PPCD for
preparation of facilities/itemsneeded and to the Security
Office for the entry of visitors
1 working day ExecutiveAssistant
PPCD
Security
ApprovedRequest
Letter
3 Pay rental charges Accepts payment of fees 5 minutes Cashier Receipt of Payment
4
Give copy of Official Receipt Gets copy of Official receipt for
recording purposes
5 minutes Executive
Assistant
Copy of
Official
Receipt
END OF TRANSACTION
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FEEDBACK FORM(Pananaw o Puna)
Please let us know how we have served you. You may use this form for compliment, complaints, or suggestions. Simply check the corresponding box.Ipaalam po ninyo sa amin kung paano naming kayo napaglingkuran. Maaaring gamitin ito para sa papuri, reklamo o mungkahi. Mangyaring i-tsek lamang ang
kahong naaayon.
COMPLIMENT COMPLAINT SUGGESTION
(Papuri) (Reklamo) (Mungkahi)
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Person(s)/Unit/Office Concerned or Involved:___________________________________________________________________________________________________
(Mga tao/pangkat/tanggapan na may kinalaman sa papuri, reklamo, o mungkahi)
Facts or Details Surrounding the Incident:
(Kaganapan o detalyeng bumabalot sa pangyayari)
Please use additional sheet(s) if necessary
(Mangyaring gumamit ng karagdagang papel kung kinakailangan)
Recommendation(s)/Suggestion(s)/Desired Action from our Office
(Rekomendasyon/Mungkahi/Nais na aksiyon mula sa aming tanggapan)
Please use additional sheet(s) if necessary
(Mangyaring gumamit ng karagdagang papel kung kinakailangan)
Name{OPTIONAL}_______________________________________________ Office/Agency:___________________________________________________(Pangalan) (Tanggapan/Ahensya)
Address:________________________________________________________________________________________________________________________________
(Tirahan)
Contact Number(s) ( if any): ________________________________________ E-mail Address (if any) ___________________________________________
(Telepono)
Signature: _______________________________________________________ Date: __________________________________________________________
(Lagda) (Petsa)
48