Evaluation Sheet: Criteria Documents Required Per Evaluation Remarks

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Department of Education

DIVISION OF LEYTE, REGION VIII


APPLICATION FOR ESTABLISHMENT OF A STAND-ALONE SENIOR HIGH SCHOOL (SHS)

E V A L U A T I O N S H E E T
REMARKS
CRITERIA DOCUMENTS REQUIRED PER EVALUATION PASSED OR FAILED
(Pls. state reason, if Failed)

1. Stand-alone SHS to be a. Letter-request from a. Requesting Officer :


established is an urgent interested parties
need in the area to be addressed to the SDS Designation/Position :
served as indicated in the e.g. from PTA or
request or proposal. Barangay Council, etc., or Office/School :
recommendation from the Date of Request :
 Grades 11 to 12 – at SDS to open a stand-
least one (1) public alone SHS
SHS for every city or
municipality Proposed Name of School :
Address/Location :

Recommended/endorsed :
Yes No
by the SDS?
Date Recommended :

b. Justification on the need b. Justification on the need for the establishment of school of a Stand-Alone SHS, if any:
to establish a Stand-
Alone SHS

c. Track(s)/Strands to be No. of Prospective


offered as well as their Track Strand
Enrollees
respective numbers of
prospective enrollees 1.
2.
3.
4.
5.
d. School Environment d. School Environment (environmental scanning/situational analysis)
(environmental scanning/ Location/Classification Urban Area Rural Area Remote
situation analysis)
Topography/Geographical Condition of the Site:
Mountainous Coastal Plain
Catchment Area Within km. Radius from the nearest school
Mode(s) of transportation in going from home to school and vice versa:
Mode Frequency* Travel Time
(in minutes/hours)
1. Land Transportation
a. Tricycle
b. Jeepney
c. Bus
d. Motorcycle
e. Jabal-jabal
f. Others
2. Banca Ride
3. Animal Ride
4. Hiking
*whether once a day, twice, every hour, etc.

e. Proposed School e. Proposed School Improvement Plan


Improvement Plan Prepared By :
Position/Designation :
Office :
Date :
f. Proposed f. Proposed Budget/Budgetary Requirements (must be supported with breakdown)
Budget/Budgetary Supported w/
Requirements (to cover Particulars Year 1 Year 2 Year 3 Year 4 Year 5 Breakdown
proposed SHS’ crucial Yes No
resources)
Personnel Services
MOOE
Capital Outlay
Total
Budget Proposal to be Allocated in Multi-Year? YES NO
If yes, how many years?
Source of fund for the initial operation of the proposed school: DepEd LGU
g. SHS Implementation Plan g. SHS Implementation Report
Prepared By :
Position/Designation :
Office :
Date :

h. Division Inspection Report h. Division Inspection Report signed by the SDS


signed by SDS Prepared By :
Position/Designation :
Office :
Date :

2. The proposed Sangguniang Sangguniang Bayan/Panglungsod Resolution No.


establishment of a Stand- Bayan/Panglungsod
Approved By : Date:
Alone SHS must be Resolution supporting the
supported by the LGU, establishment of a stand- Position/Designation :
provided that if the land is alone SHS, duly approved by Proposed Name of School :
acquired by DepEd or a the Municipal/City Mayor, Resolution stipulates the willingness of the LGU to provide support to the establishment of the school?
private individual, this indicating therein the
YES NO
criterion is not necessary. Tracks(s) and Strand(s) to be
offered and its proposed
name

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