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ISO 9001:2015 Certified

Republic of the Philippines

Siquijor State College

North Poblacion, Larena, Siquijor

Website: https://siquijorstate.edu.ph/

Email: [email protected]

Telefax:

Doc. Code: OUR-QF-17

Revision No.: 00

Eff.: May 22, 2020

TEACHING LOAD FORM

School Year:

Semester:

Regular

Overload

Part-Time

Petition

NAME :

Home Address :

Educational Qualification :

Baccalaureate Degree : _______________________

Major : _______________________

Minor : _______________________

Note :

Master's Degree : _______________________

Major : _______________________

Indicate 6 digit code :

Doctoral Degree : _______________________

Major : _______________________

Administrative Designation/Special Assignment :

Years of teaching experience :

Public School : _______________________

Private School : _______________________

Total : _________

Dept/Subj/Yr&Sec. No. of Stud. Contact Hours Tot Contact Hours
Draggable Event
DW
Consultation
Research
Extension
Indicate inside subject block: Numbers of Hours/Week Student Contact # of 0.0
1. Course Code Lecture: 0.0 Hours (Undergrad)uate)
2. Room Number Laboratory/Shop: 0.0 Lecture: 0.0
3. Overload Other assignments CERTIFIED TRUE AND CORRECT: Laboratory: 0.0
4. # Petition Designated Work: 0.0

Student Contact # of: 0.0
5. Research, Extension & Consultation Non-Teaching Hrs: 0.0 Signature Over Printed Name Hours Graduate:
6. DPTL Code __________________ Research: 0.0 Lecture: 0.0
Effectivity January 2, 2023
 Extension: 0.0 Laboratory: 0.0
Consultation: 0.0
TOTAL: 0.0 No. of Preparations: 0.0
Recommending Approval :
Dean : Dean : _______________________________ Dean : _______________________________
Date : _______________________________ Date : _______________________________ Date : _______________________________

Analin L Agan MARY ANN M. TEMPROSA, Ph. D.
Registrar III Vice President of Academic Affairs
Date: _________________ Date: _________________

Prepare in 8 Copies
1 Personnel Officer
2 Accounting Section
3 Coa Resident Auditor
4 VP Academic Affairs
5 Dean Concerned
6 Instructor Concerned
7 Registrar
8 Cashier
APPROVED:
STEVEN J. SUMAYLO, Ph.D.
College President




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