REPUBLIC OF THE PHILIPPINESCOMMISSION ON HIGHER EDUCATION

HEDC Building, C.P. Garcia AvenueU.P. Diliman, Quezon City

(1) INSTITUTIONAL PROFILE

Name of School: _________________________________________________________________Address: __________________________________________ Region: ________________

________________________________________

Telephone Number(s): ________________________ E-mail Address: ___________________________

Type of Institution: ( ) Local University ( ) State University ( ) State University System

( ) Local College ( ) State College

Manner of Establishment: ( ) Provincial Ordinance Provincial Ordinance No: ______________________ ( ) City Ordinance City Ordinance No: _____________________ ( ) Municipal Ordinance Municipal Ordinance No: _____________________ ( ) Republic Act Republic Act No: _____________________

Mandate: _____________________________________________________________________________

Year Established: __________________________ Date of Operation: ____________________________

No. of Years in Operation: ___________________

(2) ORGANIZATION

Governing Board: ( ) Board of Trustees ( ) Board of Regents ( ) Others

Chairman and Members of the Board Representation

1) _____________________________ ________________________________2) _____________________________ ________________________________3) _____________________________ ________________________________4) _____________________________ ________________________________5) _____________________________ ________________________________6) _____________________________ ________________________________7) _____________________________ ________________________________8) _____________________________ ________________________________

Board Secretary: ________________________________ Contact No. ______________________

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(3) ADMINISTRATION

Name of President: __________________________________ E-mail Address: ____________________

Status of Appointment: ( ) Regular ( ) Temporary Part-time ( ) Part time ( ) Others

Educational Attainment: __________________________________________

( ) BA / BS in _______________________________

( ) With Masteral Degree Specify the Program ______________________

( ) With Doctoral Degree Specify the Program ______________________

( ) Others Specify the Program ______________________

Name of Vice-President for Academic Affairs _________________________ Contact No. ___________

Status of Appointment: ( ) Regular ( ) Temporary Part-time ( ) Part time ( ) Others

Educational Qualification: _________________________________________

( ) BA / BS in _______________________________

( ) With Masteral Degree Specify the Program ______________________

( ) With Doctoral Degree Specify the Program ______________________

( ) Others Specify the Program ______________________

Name of Vice-President for Administration __________________________ Contact No. _____________

Status of Appointment: ( ) Regular ( ) Temporary Part-time ( ) Part time ( ) Others

Educational Qualification: _________________________________________

( ) BA / BS in _______________________________

( ) With Masteral Degree Specify the Program ______________________

( ) With Doctoral Degree Specify the Program ______________________

( ) Others Specify the Program ______________________

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(4) FACULTY PROFILE

Total Number of Faculty ____________________________

Number of Full-time Faculty ____________________________

Number of Part-time Faculty ____________________________

Number of Contractual Faculty _______________

Total Number of Faculty with Doctoral Degree _______________

Total Number of Faculty with Masteral Degree _______________

Others, pls. specify _______________

(5) STUDENT PROFILE

A. List of Students (Use separate sheet)

Name of Student Address Year/Course

B. List of Foreign Students (Use separate sheet)

Name of Student Nationality Year/Course Remarks

(6) PHYSICAL FACILITIES

6.1 Land Area

Size _____________________ (in Square Meters)

Nature of possession

( ) Owned( ) Rented( ) Shared with other Public institutions( ) Others, pls. specify

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6.2 School Building/s

( ) Owned and constructed by the Local Government exclusively for LUC( ) Rented building exclusively for LUC use( ) Shared with other departments i.e. Provincial/City/Municipal hall, buildings/structure/hospitals( ) Shared with other public educational institution i.e. Elementary or High School building( ) Water supply, lighting and ventilation( ) Others, pls. specify _________________

6.3 Description

( ) Newly built made of concrete materials (constructed 8 years ago or less)( ) Old building made of light materials (constructed 9 years ago or more)( ) Newly renovated( ) Others, pls. specify _________________

6.4 Size

( ) Spacious enough to accommodate entire students Specify size _____________________

( ) Spacious enough to accommodate at least 50% of the students Specify size _____________________

( ) Too small to accommodate students Specify size _____________________

( ) Others, pls. specify __________________

(7) BUDGET

A. Source( ) Budget sourced from the regular appropriationAmount Php __________________

( ) Special trust fundAmount Php __________________

( ) Budget sourced from tuition fees, donations, grants and income generating activitiesAmount Php __________________

( ) Subsidized by charitable organizations, public and private donorsAmount Php __________________

( ) Others, pls. specify _____________________

B. Budget Appropriated at the initial operation of SUCs/LUCs Php __________________Source __________________Year Granted/Appropriated ________________

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C. Yearly appropriated Php __________________Source _______________________________Other Conditions, pls. Specify ________________________________________

1. PROGRAM OFFERINGS (Use separate sheet)

Program Offering Date Offered Government Authority(Ordinance / Resolution /

CHED Order)Vocational/Technical Courses

Undergraduate program/Baccalaureate DegreeGraduate program

Professional courses/programs

(Program requiring licensure examinations administered by the Professional Regulatory Commission (PRC) and other government agency)

Courses/Program Date Offered

Government Authority(Ordinance /

Resolution / CHED Order)

Board Performance(Attached separate sheet)

1.1 SPECIFIC PROGRAM OFFERING (To be filled up for individual program offerings using a separate form)

Program/course offering: _______________________________ Date Offered _____________

Date of issuance of initial permit/authority given ____________ Year recognized ____________(Indicate CHED Authority)

Number of enrollment for the current year ________________(Attached enrollment data)

1.2 GRADUATE DATA (Use separate sheet)

Programs Academic Year2004-2005 2005-2006 2006-2007 2007-2008 2008-2009

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ADMINISTRATION (to be filled up for individual course/program offering)

Dean/Director: ______________________________________ E-mail Address: ____________________

Status:

( ) Regular( ) Temporary/Part time( ) Part time( ) Others

Qualification:

Educational Attainment _____________________________________________________

( ) with Doctoral degree Specify ________________________________________( ) with Masteral degree Specify ________________________________________( ) Others, pls. specify ________________________________________

Work experience:

Years of teaching experience ___________________Administrative experience ___________________Previous employment ___________________( ) Others, pls. specify ___________________

1. FACULTY QUALIFICATIONS

(Educational qualifications must be related with the course taught by the faculty)

No. of Faculty No. of Part Time Faculty Total

With Ph.D.

With MA

Degree

With MA

Units

With Ph.D. Units

With Ph.D.

With MA

Degree

With MA

Units

With Ph.D. Units

Total Number of Qualified Faculty:

Regular____________ Part-Time _____________ Contractuals ___________

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LIST OF QUALIFIED FACULTY MEMBERS PER PROGRAM (Use separate sheet)

Name of FacultyHighest Educational

AttainmentCurrent Degree Program

enrolled

No. of Units

finished

2. LIBRARY

Name of Librarian ___________________________________ Email Address: _____________________

Educational qualification ________________________________________________________________

Support Staff ____________________________________ Educational qualification ________________

2.1 Library room

Space:

( ) Separate, exclusively for the college( ) Shared with other disciplines/department

Lighting and ventilation:

( ) Well lighted and ventilated( ) Well lighted but poorly ventilated( ) Well ventilated but poorly lighted( ) Poorly lighted and poorly ventilated

Reading room/area: (requirements must be based on specific requirements of program)

( ) Sufficient to accommodate at least 25% of enrolled students in one seating( ) Sufficient to accommodate at least 15% of enrolled students in one seating( ) Can accommodate less than 15% of the enrolled students in one seating

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2.2 Library Holding/Collection

Core subjects

( ) More than 75% of the total book collection( ) Less than 75% of the total book collection( ) Less than 50% of the total book collection

Recency of edition (Not more than 10 years)

( ) More than 75% of the total book collection( ) Less than 75% but more than 50% of the book collection( ) Less than 50% of book collection

No. of titles per subject

( ) 5 ( ) 2( ) 4 ( ) 1( ) 3

General reference

_______________________________ _______________________________

_______________________________ _______________________________

Filipiniana

_______________________________ _______________________________

_______________________________ _______________________________

Professional publications/International journals

_______________________________ _______________________________

_______________________________ _______________________________

e-Library

_______________________________

_______________________________

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(8) OTHER PERTINENT DATA

8.1 Tracer Study / Data on Employability (Use separate sheet)

Name of Students Work/Profession/Businees Undertaking

8.2 List of Local and International Linkages (Use separate sheet)

Name of Organizations / Institutions

Country / Address Nature of Linkages

8.3 Extension Program/Alumni Association (Use separate sheet)

List of Program/Projects Nature of Activities

Date of visit/inspection: _______________________

VALIDATION TEAM

______________________________Chairman

________________________________ _________________________________Member Member

Conforme: ___________________________

Date: ___________________________

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