Form 1 and Accreditation Number

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Republic of the Philippines

Northwest Samar State University


Rueda St., Calbayog City 6710
Website: http//www.nwssu.edu.ph
Doc. Code: SBO-QF-01
Email: [email protected]
Revision No.: 00
Telefax: (055) 2093657 Eff.: 08/01/2019
ISO 9001:2015 Certified

OFFICE OF THE STUDENT ORGANIZATIONS

Date of Filing: _____________


Madam:

We, the members of ___________________________________________ (Name of the


Organization) of _______________________________________ (Name of College/Department)
for this school year 2019 – 2020 would like to apply for registration and accreditation of our
organization.
In this connection, we would like to submit the following documents to wit:
New Registration Renewal
( ) Constitution and By-Laws ( ) Calendar of Activities
( ) Form 1 – Student Organization Registration Form ( ) Organization Accreditation Number
( ) Form 2 – Officers Data Sheet ( ) Form 2 – Officers Data Sheet
( ) Form 3 – Faculty Adviser Data Sheet ( ) Form 3 – Faculty Adviser Data Sheet
( ) Form 4 – Roster of Members ( ) Form 4 – Roster of Members
( ) Form 5 – Action Plan ( ) Form 5 – Action Plan
( ) 1 Documentary Stamp ( ) Form 6 – Financial Report
( ) 1 Documentary Stamp
( ) Accomplishment Report
Yours truly,

_________________________
President of the Organization
Noted:

_________________________
Faculty Adviser
Reviewed by:

____________________
Head, Student Organizations

Recommending Approval:

___________________ _____________________
Director, Student Affairs and Services Vice President, Academic Affairs
Approved:

______________
University President
Republic of the Philippines
Northwest Samar State University
Rueda St., Calbayog City 6710
Website: http//www.nwssu.edu.ph
Doc. Code: SBO-QF-01
Email: [email protected]
Revision No.: 00
Telefax: (055) 2093657 Eff.: 08/01/2019
ISO 9001:2015 Certified

STUDENT AFFAIRS AND SERVICES

OFFICE OF THE STUDENT ORGANIZATIONS

To All Persons To Whom This May Present:

Be it known that pursuant to the provisions of the Northwest Samar State University Student
Handbook on the Policies and Guidelines of the Student Organization, the SAS office through the
Office of the Student Organization has awarded.

ACCREDITATION
For S.Y. 2019-2020

JUNIOR PHILIPPINE INSTITUTE OF CIVIL ENGINEERS (JPICE) – NwSSU


CHAPTER

ACCREDITATION NO.
CET-1920-01

Of
Northwest Samar State University.

With all rights and privileges as well as obligations and responsibilities thereunto appertaining.

In testimony thereof, the seal of the university and signature of the university President are
hereunto affixed.

BENJAMIN L. PECAYO, Ed. D


University President

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