HRDO Form C‐1 Revised Jan. 9, 2020
UNIVERSITY OF THE PHILIPPINES DILIMAN HUMAN RESOURCE DEVELOPMENT OFFICE
APPLICATION FOR PRIVILEGE TO STUDY AT REDUCED FEES
Name : _____________________________________ Designation: _________________________
Student No.: _____________ Degree Course: ____________ Home Unit: __________________________
First Availment
______ Renewal_______ Semester/Summer/Trimester AY __________
S u b j e c t s D a y s U n i t s
_____________________ ______________ ________________
_____________________ ______________ ________________
_____________________ ______________
T i m e ______________
______________
______________ ________________
Total Unit Enrolled in: ________________
______________________
Signature
*Please attach true copy of grades from previous semester
ACADEMIC LOAD OF APPLICANT (If applicable only) CLEARANCE:
[To be filled out by Department Chairman]
[ ] Tenured
Actual teaching load units : _________ [ ] Non‐tenured ____________________
Unit credits for non‐teaching activity ‐ [ ] On study leave___________________
a) Research : _________ [ ] On vacation leave with pay ________
b) Administrative Work : _________
c) Study : _________ For enrollment in not more than _______
Total Units : _________ units with only _______ units at reduced fees.
Inclusive dates of current
Appointment: _______________________________________
RECOMMENDED BY:
______________________ ______________
Chairman Date
______________________ ______________
Dean/Director/Head Date
RECOMMENDING APPROVAL / APPROVED: RECOMMENDING APPROVAL/APPROVED:
(For Faculty/REPS) (For Administrative)
MA. THERESA T. PAYONGAYONG
Vice‐Chancellor for Academic Affairs
ADELINE A. PACIA
Vice Chancellor for Administration APPROVED:
(For more than 18 units academic load)
Chancellor
-
AUGUSTUS C. RESURRECCION
Director
Human Resource Development Office
FIDEL R. NEMENZO ---
0.0
0.0
