Eligibility Form Update 2024

Office for Student Affairs and Services
REMINDERS:
1. LONG BOND paper only.
2. STRICTLY ONE PAGE ONLY FOR ELIGIBILITY FORM
3. A. Attach a CHECKLIST for top sheet.
B. SEE the FORMAT of the CHECKLIST at PAGE 4.
C. DO NOT check the tables. LEAVE IT BLANK.
4. Attach the Approved Letter and Transmittal Letter of the activity (example of transmittal
at page 3)
a. Approved letter SHOULD have a NOTE from OSAS and DRRMO.
5. Attach the ACTIVITY APPROVAL FORM. (page 5)
6. Check the details before passing. Make SURE TO CHANGE ALL the necessary details
BEFORE PRINTING.
7. SIGNATORIES (Noted) – PLEASE READ CAREFULLY
a. ACADS purpose: DEAN signatory at Program Chairs INITIAL Signature
b. NON-ACADS(CSG) purpose: MA’AM MENA signatory at adviser INITIAL Signature
c. NON-ACADS(ORGS) purpose: MA’AM CHARM signatory at adviser INITIAL Signature
d. LABORATORY HIGHSCHOOL: Dr. LOIDA MARASIGAN signatory at adviser INITIAL
Signature
8. PHOTOCOPY OF PARENTS’ VALID ID WITH SIGNATURE is a MUST.
a. SHOULD BE LONG BOND paper
9. STAPLE the waivers and consent together with the photocopy of parents’ valid ID.
10.SORT the waivers based on the checklist.
11.IN CASES where medical is REQUIRED, the ADVISER WILL SEND A LETTER TO THE CLINIC
for group medical; WAIT FOR THE SCHEDULE provided by the clinic; DO NOT make an
individual appointment. If NOT REQUIRED, write N/A.
12.In case of confusion, you can inquire at our office, Students Affairs and Services before
reproducing.
13.OSAS will a give a CERTIFICATE OF COMPLETION for those who successfully accomplished
their requirements.
STRICTLY PASS 2 WEEKS BEFORE THE EVENT

THANK YOU 😊
Student Center Bldg., MinSU Main Campus, Alcate, Victoria, Oriental Mindoro | Mobile: 09278071202
[email protected] | www.minsu.edu.ph
ELIGIBILITY FORM MSU-SAS-FR.04.02

Name of Participant: Event:
College Nature of Activity:
Year and Section:
Address: Requested by:
Contact Number: Name of the Adviser
MEDICAL CERTIFICATE PARENT’S CONSENT

This is to certify that I have full knowledge of and
This is to certify that: permission for my son / daughter / foster child to
join and participate the PLACE THE NAME OF
PLACE YOUR NAME HERE ACTIVTY HERE, on PLACE DATE HERE at PLACE
VENUE HERE.
is Physically Fit to participate in PLACE THE
ACTIVITY HERE that will be held on PLACE I am aware that there are faculty members who
DATE HERE at PLACE VENUE HERE. will accompany and take all the necessary
precautions to keep everyone safe. However, if,
despite all efforts taken, untoward incidents occur
during or while traveling to and from the activity, I
_________________________ hereby release Mindoro State University, the
CORALYN V. BAUTISTA, M.D. Commission on Higher Education, and all other
University Physician concerned parties, individual or group, from any
claims, da0mages, demands, or actions whatsoever
that may arise.
Blood Pressure:
_____________________________
Date of Examination: NAME OF PARENT OR GUARDIAN & SIGNATURE
Contact Number: 0917 123 4567
STUDENT’S WAIVER
Date 01, 2023
To whom it may concern:
This is to certify that I am voluntarily joining my organization’s extra/co-curricular activity,

particularly, the PLACE THE NAME OF THE ACTIVITY HERE, which will be held on PLACE DATE HERE at
PLACE THE VENUE HERE. I also declare that neither MINSU or its officials, the Commission on Higher
Education, and all other concerned parties, should be held responsible for any untoward incident that
may occur during or while travelling to and from the said activity.
NAME OF THE STUDENT & SIGNATURE

Member, Name of CSG
Noted: Acknowledged:
MENA P. CAOLI ADELIO D. CUETO, MSP, CHRA

Adviser, University Student Government Coordinator, Student Affairs and Services
(EXAMPLE OF TRANSMITTAL LETTER)

November xx, xxxx
ADELIO D. CUETO
Coordinator, Office of the Student Affairs and Services
This Campus
Dear Sir:
Good Day!
This is to inform your good office that the STATE THE COLLEGE/ORG STUDENT/MEMBER/OFFICER (e.g.,
College of Computer Studies students) will participate the STATE THE EVENT on STATE THE DATE at
STATE THE PLACE.
In line with this, kindly acknowledge the eligibility form and valid ID of the parents/guardian of the said
students. Attach herewith are the Approved letter and checklist of the students. Your approval will benefit the
student’s in showcasing their skills related with their program.
Looking forward to your favorable response in this matter.
Respectfully yours,
NAME OF THE ADVISER IN THE ELIGIBILITY FORM

Adviser
IN/OFF - CAMPUS STUDENTS’ ACTIVITY

CHECKLIST MONITORING
ACTIVITY: DATE OF THE ACTIVITY:
STUDENT’S INVOLVED:
NO NAME ELIGIBILITY FORM

. MEDICAL PARENT PARENT’S
(UPPERCASE (LN, FN MI)) REMARKS
CERTIFICATE CONSENT VALID ID
1
2
3
Prepared by:
NAME OF ADVISER
Adviser
Verified by:
____________________
SAS STAFF
ACTIVITY APPROVAL FORM MSU-SAS-FR.04.01

q Academic q Organizational Development Tracking Code:

q Community Engagement/ Outreach q Special Interest
q Issue Advocacy q Departmental
q Fundraising q Others _______________
REQUESTING ACTIVIT
ORGANIZATI Y TITLE
ON
ACTIVITY Subchapter/ Program DATE/s VENUE
REACH Campus Wide
University Wide START END RECURRIN NO. OF DAYS
External TIME TIME G?

YES /
NO
Is activity in FUNDING
AP? TOTAL BUDGET SOURCE SPONSORS (If any)
YES / NO ESTIMATE
REQUESTED
UNIVERSITY FACILITY
SUBMITTED BY: DEAN/ PC FOR CO-CURRICULAR ACTIVITIES OTHER CONCERNED UNITS
Signature over Printed Name Signature over Printed Name Signature over Printed
Project/ Committee Head/ Secretary Dean, ______ PC_____ Name
___________________
 Noted
Signature over Printed Name  Recommending Approval
Organization President
JONBERT M. CAOLI
Director for Student Affairs and Services
Signature over Printed Name

For and in behalf:
Organization Adviser
ADELIO D. CUETO
Coordinator, Student Affairs and Services, MinSU Calapan City Campus
Remarks:
----------------------------------------------------- FOR FINANCE/ OSAS/VPAA/OP USE ONLY--------------------------------------
CERTIFICATION OF AVAILABLE ALLOTMENT  Recommending Approval

(If funds are requested.)  Approved
ELVI C. ESCAREZ. Ph.D.

Campus Executive Director, MinSU Calapan City Campus
Recommending Approval  Approved

 Disapproved
NEMESIO H. DAVALOS, Ph.D.

Vice President for Academic Affairs
ENYA MARIE D. APOSTOL, Ph.D.
SUC President II

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Office for Student Affairs and Services

STRICTLY PASS 2 WEEKS BEFORE THE EVENT

ELIGIBILITY FORM MSU-SAS-FR.04.02

MEDICAL CERTIFICATE PARENT’S CONSENT

Date 01, 2023

To whom it may concern:

This is to certify that I am voluntarily joining my organization’s extra/co-curricular activity,

NAME OF THE STUDENT & SIGNATURE

MENA P. CAOLI ADELIO D. CUETO, MSP, CHRA

(EXAMPLE OF TRANSMITTAL LETTER)

Looking forward to your favorable response in this matter.

NAME OF THE ADVISER IN THE ELIGIBILITY FORM

IN/OFF - CAMPUS STUDENTS’ ACTIVITY

NO NAME ELIGIBILITY FORM

ACTIVITY APPROVAL FORM MSU-SAS-FR.04.01

q Academic q Organizational Development Tracking Code:

 External TIME TIME G?

SUBMITTED BY: DEAN/ PC FOR CO-CURRICULAR ACTIVITIES OTHER CONCERNED UNITS

Signature over Printed Name

----------------------------------------------------- FOR FINANCE/ OSAS/VPAA/OP USE ONLY--------------------------------------

CERTIFICATION OF AVAILABLE ALLOTMENT  Recommending Approval

ELVI C. ESCAREZ. Ph.D.

Recommending Approval  Approved

NEMESIO H. DAVALOS, Ph.D.

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External TIME TIME G?