TESDA-OP-CO-01-

F03 (Rev.No.00-
03/08/17)

(Letter Head of the TVI/Company)

LETTER OF APPLICATION/INTENT

Date

The Provincial Director

Dear Sir/Madam:

We would like to express our intention to apply for program registration

for the following qualification(s):
Qualificati Training
on Duration (No.
of Hours)
1.
2.
3.

Enclosed are the required documents.

We hope for your immediate action on this application.

Very truly yours,

Signature over Printed

Name (President/Head
TVI/Company)

Attachments: (As indicated in the Program Registration Checklist)

1. Corporate Administrative Documents
2. Curricular Requirements
3. Faculty and Personnel
4. Program Guidelines
5. Support Services
 TESDA-OP-CO-01-
F04 (Rev.No.00-
03/08/17)

Program Registration Requirement Checklist

(For Institution-based Programs)

Name of TVI KLM Eurika Technical College, Inc

Address Lapu-Lapu St., Aplaya,
Bongabong,Oriental Mindoro Tel/Fax No.:(043) - 283-
5939
Program Applied Hilot (Wellness Massage) Duration: (120 hours)
No. of trainees per batch:25
Training Capacity No. of batches per year:10
Program Registration Requirements
Compliant
Yes No Remarks
1. CORPORATE AND ADMINISTRATIVE
DOCUMENTS
a) Letter of Application/Intent (TESDA-
OP-CO-F03)
b) Board Resolution/Academic Council
Resolution to offer the program signed
by the Board Secretary and attested
by the Chairperson (SUCs, LCUs, and
private institutions) Board
Resolution/Academic Council
Resolution must specifically cover the
training delivery site)
c) Special law creating the institution
(for public institution) e.g.
Republic Act, Executive Order,
Sanggunian
Resolutions)
d) Securities and Exchange Commission
(SEC) Registration for private
institutions
e) Articles of Incorporation (indicate main
address)
f) Proof of building Ownership or
contract of lease (covering at least two
years) upon application for new
program. For succeeding application a
valid contract of lease
g) Current Fire Safety Certificate
(training site)
h) For Institutions that will branch out
Name of TVI KLM Eurika Technical College, Inc
Address Lapu-Lapu St., Aplaya,
Bongabong,Oriental Mindoro Tel/Fax No.:(043) - 283-
5939
Program Hilot (Wellness Massage) Duration: (120 hours)
Applied
No. of trainees per batch:25
Training No. of batches per year:10
Capacity
Program Registration Requirements
Compliant Remarks
The Articles of Incorporation &
Bylaws must state reasons for
opening of the branch. The
Articles of Incorporation signed by
majority of the Incorporators
must be notarized and received
by SEC
2. CURRICULAR REQUIREMENTS
a) Competency-based Curriculum
(TESDA-OP-CO-01-F11) indicating
the qualification being addressed
and the competencies to be
developed
a.1 Course Design
a.2 Modules of Instruction
b) List of Equipment (TESDA-OP-CO-
01- F13), Tools (TESDA-OP-CO-
01-F14)
and Consumables/Materials
(TESDA- OP-CO-01-F15) necessary
to deliver the program
c) List of instructional materials
(TESDA- OP-CO-01-F16) (such as
reference materials, slides, video
tapes, internet access and library
resource necessary
to deliver the program
d) List of Physical Facilities
(TESDA- OP-CO-01-F17) and
List of Off- Campus Physical
Facilities TESDA- OP-CO-01-
F18)
e) Shop layout of training facilities
indicating the floor area
f) Institutional Assessment
Note: Actual Assessment Tools
should be shown during inspection
3. FACULTY AND PERSONNEL
a) List of Officials (TESDA-OP-CO-01-
F19)
Name of TVI KLM Eurika Technical College, Inc
Address Lapu-Lapu St., Aplaya,
Bongabong,Oriental Mindoro Tel/Fax No.:(043) - 283-
5939
Program Hilot (Wellness Massage) Duration: (120 hours)
Applied
No. of trainees per batch: 25
Training No. of batches per year: 10
Capacity
Program Registration Requirements
Compliant Remarks
b) List of Trainers (TESDA-OP-CO-01-
F20) with their qualifications,
areas of expertise, and
courses/seminars attended with
supporting evidence available,
such as relevant NTTC/trainer
qualification certificates and
certification of employment. For
NTR programs, copy of Training
Certificate on Trainers
Methodology I or other Trainer
Methodology Certificates, and
evidence of specialization of the
trainer of the program. A
certified true copy of
notarized contract of employment
by the applicant TVI is required.
c) List of Non-Teaching Staff
(TESDA-OP-CO-01-F21) with their
qualifications with supporting
evidences available, such as
copies of certificates/contracts
of employment,
etc.
4. PROGRAM GUIDELINES
a) Program fees, with breakdown of
tuition and other fees and
schedule of fee payment duly
signed by the school head
indicating the effectivity of school
year
b) Documented grading system,
details of which are provided to
students/ trainees at the start of
their program
c) Entry requirements for the
program comply with the relevant
training regulations if applicable
Name of TVI KLM Eurika Technical College, Inc
Address Lapu-Lapu St., Aplaya,
Bongabong,Oriental Mindoro Tel/Fax No.:(043) - 283-5939
Program Hilot (Wellness Massage) Duration: (120 hours)
Applied
No. of trainees per batch: 25
Training No. of batches per year: 10
Capacity
Program Registration Requirements
Compliant Remarks
d) Rules on attendance

5. SUPPORT SERVICES
a) Health services are available to the
students/trainees. If these services
are contracted out or out-sourced,
the contract or MOA or similar
documents
must be submitted.
b) Job Linkaging and Networking
Services (JLNS) which include
Career Services and Employment
Facilitation available to
students/trainees/TVET graduates
(reference: Section IV, letter A –
Delivery Platforms of JLNS Nos. 1-4
of the TESDA Circular No. 38,
series of
2016)
c) Community outreach program
– optional
d) Research program, activities that
will support continuing
development of the program of the
school – optional
6. Additional Requirements for DTS/DTP Applicants
a) Application Letter of the TVI and
the
Establishment
b) Accomplished Application form for
TVI and for Establishment
c) Photocopy of TVI’s CTPR
d) Photocopy of Establishment SEC
Registration
e) Memorandum of Agreement with
partner Establishment/s
f) Training Plan (DTS Form 5)
g) Certification issued by the TVI
designating the Industrial
Coordinator
 Name of TVI KLM Eurika Technical College, Inc
Address Lapu-Lapu St., Aplaya,
Bongabong,Oriental Mindoro Tel/Fax No.:(043) - 283-5939
Program
Hilot (Wellness Massage) Duration: (120 hours)
Applied
No. of trainees per batch: 25
Training No. of batches per year: 10
Capacity
Program Registration Requirements
Compliant Remarks
h) Certification issued by the
company designating the In-plant
Trainer
Forms – refer to TESDA Circular No. 31
Series 2012 - Guidelines in
Implementing the Dual Training System
(DTS) Programs and Dualized Training
Programs (DTP)
7. Requirements for Mobile Training Application
a) Copy of CTPR of the
registered institution-based
program
b) Copy of the approved program
registration documents
c) LTO Registration of the prime
mover of
the MBC ( for delivered in a self
contained van)
d) Design/lay-out of the MBC
Reference: TESDA Circular No. 27 Series
of 2009 Operational Polices in the
Registration of Mobile Training
Classrooms, Park and Training Programs
(MBC-MTP) and TESDA Order 28 Series
in 2012 – Addendum and Amendments
to the Guidelines and Registration of
Mobile Training Program
(MTP)
(Note: Erasure is not allowed on the submitted checklist of requirements)
General Comments/Remarks:

Prepared by: Noted by:

CELY M. JAYLO PD BEN-HUR B. BANIQUED
PO UTPRAS Focal Person Provincial Director
Date: Date:
 TESDA-OP-CO-00-
F05 (Rev.No.00-
03/08/17)

Program Registration Requirement Checklist

(Company/Enterprise-based Programs)
Name of
Company
Address Tel/Fax No.:
Program Applied Duration: (in hrs.)
No. of Trainees per batch:
Training Capacity No. of Batches per year:
Program Registration Requirements
Compliant
Program Registration Requirements Yes No Remarks
1. CORPORATE AND
ADMINISTRATIVE DOCUMENTS
a) Letter of
Application/Intent
(TESDA-OP-CO-F01)
b) Securities and Exchange
Commission (SEC) Registration
for Corporation.
For sole proprietorship, a DTI
Registration is required.
c) Proof of building ownership or
contract of lease (covering at
least two years) upon
application for new program.
For succeeding application a
valid contract of lease)
d) Current Fire Safety
Certificate
(training site)
2. CURRICULAR REQUIREMENTS
a) Competency-based
Curriculum (TESDA-OP- CO-
01-F08)
indicating the
qualification being
addressed and the
competencies to be
developed
a.1 Course Design
a.2 Modules of Instruction
b) List of Equipment (TESDA-
OP- CO-01-F13), Tools
(TESDA-OP-
CO-01-F14), and
Consumables
(TESDA-OP-CO-01-F15)
necessary to deliver the
program
 Name of
Company
Address Tel/Fax No.:
Program Applied Duration: (in hrs.)
No. of Trainees per batch:
Training Capacity No. of Batches per year:
Program Registration Requirements
Program Registration Requirements Compliant Remarks
c) List of Physical Facilities
(TESDA-OP-CO-01-F17) and
List
of Off-Campus Physical
Facilities TESDA-OP-CO-01-
F18) indicating
floor area
d) Shop layout of training
facilities indicating the floor
area
3. Trainer/HRD Personnel
a) List of Trainers (TESDA-OP-CO-
01-F20) with their
qualifications, areas of
expertise, and cours-
es/seminars attended with
sup- porting evidence

available, such as relevant

NTTC/trainer qualification
certificates and
certification of employment.)
(Note: Erasure is not allowed on the submitted checklist of requirements)

General Comments/Remarks:

Prepared by: Noted by:

PO UTPRAS Focal Person Provincial

Date: Director Date:
 TESDA-OP CO-01-
F11 (Rev.No.00-
03/08/17)

COMPETENCY-BASED CURRICULUM

A. Course Design

Course Title:
Nominal
Duration:
Qualification
Level: Course
Description:

Trainee Entry
Requirements:

Course
Structure Basic
Competencies No.
of Hours: (

)
Unit of Module Title Learning Nominal
Competency Outcomes Duration

Common
Competencies No. of
Hours: ( )
Unit of Compe- Module Title Learning Nomin
tency Outcome al
s Duratio
n

Core
Competencies No.
of Hours:(

)
Unit of Module Title Learning Nominal
Competency Out- Duration
 comes

Elective Competencies ( if
any) No. of Hours: ( )
Unit of Module Title Learning Nominal
Competency Outcomes Duration
 Assessment Methods:

Course Delivery:

Resources:

(List of recommended tools, equipment and materials for the

training of (no. of trainees) trainees for (title of
program/qualification).

Qty. Tools Qty. Equipment Qty. Materials

Facilities:

Qualification of
Instructors/Trainers:

B. Modules of Instruction

Basic Competencies :
Unit of Competency :
Modules Title:
Module Descriptor:
Nominal Duration:
Summary of Learning Outcomes:
LO1.
LO2.
LO3.

Details of Learning Outcomes:

LO1 .

Assessment Contents Conditions Methodologies Assessment

Criteria Methods
LO2 .

Assessment Contents Conditions Methodologies Assessment

Criteria Methods

LO3 .

Assessment Contents Conditions Methodologies Assessment

Criteria Methods

(Note: Copy format for modules of instructions for Common and Core
Competencies)
 TESDA-OP-CO -01-
F13 (Rev.No.00-
03/08/17)
LIST OF EQUIPMENT
(As listed in the respective
TR)

Program:
Name of
Institution/Company:

Name of Specification Quantity Quantity Difference Inspector’s

Equipment Required on Site Remarks
(1) (2) (3) (4) (5) (6)

Note: Columns 1-4 to be filled out by Institution/Company; Columns 5-6 to be filled out
by PO/Expert Continue in additional sheet

Submitted by: Attested by:

TVI/Company TVI/Company Head

Representative Date: Date:
Inspected by:

PO UTPRAS Focal Person Exper

Date: t
Date:
 TESDA-OP-CO 01-
F14 (Rev.No.00-
03/08/17)
LIST OF TOOLS
(As listed in the respective
TR)

Program:
Name of TVI/Company:

Name of Specification Quantity Quantity Difference Inspector’s

Tools Required on Site Remarks
(1) (2) (3) (4) (5) (6)

Note: Columns 1-4 to be filled out by Institution/Company; Columns 5-6 to be filled out
by PO/Expert Continue in additional sheet

Submitted by: Attested by:

TVI/Company TVI/Company Head

Representative Date: Date:
Inspected by:

PO UTPRAS Focal Person Exper

Date: t
Date:
 TESDA-OP-CO-01-
F15 (Rev.No.00-
03/08/17)
LIST OF CONSUMABLES/MATERIALS
(As listed in the respective TR)

Program:
Name of TVI/Company:

List of Specification Quantity Quantity Difference Inspectors

Consumables/ Required on Site (5) Remarks
Materials (2) (3) (4) (6)
(1)

Note: Columns 1-4 to be filled out by Institution; Columns 5-6 to be filled out by
PO/Expert Continue in additional sheet

Submitted by: Attested by:

TVI/Company TVI/Company Head

Representative Date: Date:
Inspected by:

PO UTPRAS Focal Person Expe

Date: rt
Date:
 TESDA-OP-CO -01-
F16 (Rev.No.00-
03/08/17)

LIST OF INSTRUCTIONAL MATERIALS/LIBRARY HOLDINGS

Program:
Name of TVI:

Title Classification* Date of No. of Copies Inspector’s

Publication (where applicable) Remarks

Note *Classify whether journal, book, magazine, electronic materials available on

electronic media or in the internet, etc.
Columns 1-4 to be filled out by Institution/Company; Column 5 to be filled out by
PO/Expert Continue in additional sheet

Submitted by: Attested by:

TVI TVI Head

Representative Date:
Date:
Inspected by:

PO UTPRAS Focal Person Exper

Date: t
Date:
 TESDA-OP-CO-01-
F17 (Rev.No.00-
03/08/17)

LIST OF PHYSICAL FACILITIES

(As listed in the respective TR)

Program:
Name of TVI/Company:

Facility Description Quantity Inspector’s Remarks

Note: Columns 1-3 to be filled out by Institution/Company; Column 4 to be filled out by

PO/Expert Continue in additional sheet

Submitted by: Attested by:

TVI/company TVI/Company Head

Representative Date: Date:
Inspected by:

PO UTPRAS Focal Person Exper

Date: t
Date:
 TESDA-OP-CO-01-
F18 (Rev.No.00-
03/08/17)

LIST OF OFF-CAMPUS PHYSICAL FACILITIES

Program:
Name of TVI/Company:

Facility Description Quantity Inspector’s Remarks

Note: Columns 1-4 to be filled out by Institution/Company

Continue in additional sheet

Submitted by: Attested by:

TVI/Company TVI/Company Head

Representative Date: Date:
Inspected by:

PO UTPRAS Focal Person Exper

Date: t
Date:
 TESDA-OP-CO-01-
F19 (Rev.No.00-
03/08/17)

LIST OF OFFICIALS

Program:
Name of Institution:
Contact Details
Name Position (Address) Contact No. Email Address Nature of Educational
Appointment Attainment

Note: Columns 1-5 to be filled out by Institution

Continue in additional sheet

Submitted by: Attested by:

TVI Representative TVI Head

Date: Date:
Inspected by:

PO UTPRAS Focal Person Expe

Date: rt
Date:
 TESDA-OP-CO-01-
F20 (Rev.No.00-
03/08/17)
LIST OF TRAINERS

Program:
Name of Institution/Company:
Name Position Nature of Educational No. of No. of Years of Trainer’s
Appointment Attainment Years of Industry Experience Qualification
Teaching Relevant to the
Experience Qualification
(with Certificate of NTTC*
Validity
Employment), if Number
applicable

Note: For NTR Title of Trainers Training or other

licenses/certificates Columns 1-8 to be filled out by
Institution/Company
Continue in additional sheet
Submitted by: Attested by:

TVI/Company TVI/Head Representative

Representative Date: Date:
Inspected by:
PO UTPRAS Focal Person Expe
Date: rt
Date:
 TESDA-OP-CO-01-
F21 (Rev.No.00-
03/08/17)
LIST OF NON-TEACHING STAFF

Program:
Name of Institution:

Experience
Nature of Educational
Name Position Related to
Appointment Attainment
Position

Note: Columns 1-5 to be filled out by

Institution Continue in additional
sheet

Submitted by: Attested by:

TVI TVI Head

Representative Date:
Date:
Inspected by:

PO UTPRAS Focal Person Expe

Date: rt
Date: