CMO 63 Annex A B C

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Annex A

Republic of the Philippines


SORSOGON STATE UNIVERSITY
Sorsogon City Campus
Sorsogon City

LOCAL OFF- CAMPUS ACTIVITIES

CERTIFICATE OF COMPLIANCE

This is to certify that all the processes, procedures and requirements before the conduct of the
off-campus activity/ies pursuant to CMO No. 63, series 2017 entitled “Policies and Guidelines
on Local off- campus Activities” have been duly complied with, and that by virtue thereof, we
hereby assume full responsibility for the safety and welfare of the students.

Certified Correct: Recommending approval:

_________________________ MARIA CRISANTA M. JARQUE


Campus Director Director, Student Development and Services

JHONNER D. RICAFORT, Ph.D.


Vice- President for Academic Affairs

Approved by:

GERALDINE F. DE JESUS, Ed.D.


SUC President III

SUBSCRIBED AND SWORN to before me, this ________________, by ________________ who


exhibited to me (his/her) competent proof of identification_____________________ issued at
___________________, Philippines on ____________________.

Notary public

Doc. No. _______;


Page No. _______;
Book No. _______;
Series of _______;
Annex B
Republic of the Philippines
Office of the President
COMMISSION ON HIGHER EDUCATION

LOCAL OFF- CAMPUS ACTIVITIES

REPORT OF COMPLIANCE

NAME OF HEI: SORSOGO STATE UNIVERSITY REGION: V


ADDRESS: MAGSAYSAY STREET, SORSOGON CITY

BASIC INFORMATION:
PROGRAM COURSE DESTINATIONS INCLUSIVE NUMBER OF LIST OF
NAME AND VENUE DATES STUDENTS PERSONNEL-
IN-CHARGE

REPORT BEFORE THE ACTIVITY:


COMPLIANCE
ACTIVITIES
YES/NO REMARKS
1. Curriculum Requirement
2. Destination
3. Handbook or Manual
4. Students’ Consent of the Parents/ Guardians
Medical Clearance of the Students
5. Personnel-In-Charge
6. First Aid Kit
7. Fees/ Funds
8. Insurance
9. Mobility of Student (vehicles) Owned by the
HEI, Third Party or Subcontracting
Franchise/Travel Agency/Tour Operator
10. LGUs/ NGOs
11. Activities: Orientation to students
Consultation, Announcements ,
Briefing before the trip
Learning Journals
Emergency Preparedness Plan

Certified Correct: Recommending approval:

__________________ ________________________________
Campus Director Director, Student Development and Services

Reviewed by:
___________________ ______________________________
Dean or Program Head Vice President for Academic Affairs

Approved by:

GERALDINE F. DE JESUS, Ed.D.


SUC President III
Annex C
Republic of the Philippines
Office of the President
COMMISSION ON HIGHER EDUCATION

LOCAL OFF- CAMPUS ACTIVITIES

COMPREHENSIVE SEMESTERAL/TERM REPORT

NAME OF HEI: SORSOGO STATE UNIVERSITY REGION: V


ADDRESS: MAGSAYSAY STREET, SORSOGON CITY

PROGRAMS DESTINATIONS NO. OF STUDENT NO. OF HEI


PERSONNEL

Problems encountered and actions taken to address the situation

______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

Recommendation

______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

Certified Correct: Recommending approval:

__________________ ________________________________
Campus Director Director, Student Development and Services

____________________________________
Vice President for Academic Affairs

Approved by:

GERALDINE F. DE JESUS, Ed.D.


SUC President III

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