Form No.

11

DE LA SALLE LIPA
OFFICE OF THE REGISTRAR
J.P. Laurel National Highway, Lipa City 4217, Batangas, Philippines
Tel. Nos. (043) 756-1849, 756-1887, 756-2391, 756-2491, 757-2011
Fax: (63-43) 981-1781. Official Web Site: http://www.dlsl.edu.ph

REQUEST FORM for REGULAR/ SPECIAL CLASS OFFERING

Date: ________________ Semester:_________________ School Year: _____________

Our department would like to request for the offering of a special class ( ) / regular class ( ) in
__________________ a __________ unit subject with ______ lec units and _______ lab units.

SECTION AND CLASS SCHEDULE:

Section ___________ Day _______ Time ___________Room _______ Teacher____________________

I understand that this is not a regular subject offering and that the students who signed up on this list will be
required by our Department to enroll in this subject. I had clearly explained to them that if this will not reach
the minimum number of students set by the school (25 students during the regular semester and 15 students
during summer), the subject will be categorized as a special class and that enlisted students will be paying
the total cost equally divided to them. I have discussed the policies regarding the offering of a special/regular
class with the enlisted students in the attached form, they are amenable to these and will abide accordingly.

Requested/Endorsed to Dean for Approval: 1 Approved/Endorsed to FRD for Computation 2

Total Number of Students: ______________

_______________________________________ _______________________________________
DEPARMENT/AREA/LEVEL CHAIR DEAN
CBEAM/CIHTM/CEAS/CITE/CON/COL CBEAM/CIHTM/CEAS/CITE/CON/COL

Approved: 3
Computed:

Total Amount of the Class:

_________________________________________ Total Fee Per Student:

FRD MANAGER/REPRESENTATIVE

APPROVAL TO ENROLL / OFFICIALLY START THE REGULAR / SPECIAL CLASS

Approved for Room/ Schedule /Enrollment: Approved to Start the Class

_________________________________________ _________________________________________
ROMANA LEVINIA B. SILVA RUBEN T. RUBIS
Assistant Registrar for College Registrar
 APPLICATION FOR SPECIAL CLASS
SECOND SEMESTER OF SCHOOL YEAR 2013-2014
IMPORTANT: ALL STUDENTS WHO WILL SIGN ON THIS FORM ARE REQUIRED TO SUBMIT THE
APPROVED LETTER SIGNED BY THEIR PARENT & THE ADVISER.

STUDENT NO. STUDENT NAME CONTACT NUMBER COURSE SIGNATURE

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

16.

17.

18.

19.

20.

21.

22.

23.

24.

25.

(if more than 25 students will enroll, please photocopy this page)
POLICIES AND PROCEDURES IN THE OFFERING OF A SPECIAL CLASS:

The students requesting for Special Class should proceed to the concerned Department/Area/Level Chair to
request for the offering of the subject. Request should be processed after the issuance of grades. All grades
of students should be complete for easier evaluation of records.

The Department / Area / Level Chair processes and secures the approval of the Dean, the FRD Manager and
the Registrar.

PROCESS:

1. Secure and process Form No. 11 Request for Regular/Special Class Offering Form. Form is
available at the Office of the Registrar and is downloadable at the DLSL Website Registrars Page.
2. Secure the endorsement and approval of the College Dean regarding the opening of a Special Class
or a Regular Class depending on the number of students. The Dean will identify the faculty who will
handle the class.
3. Provide the students with the Letter to the Parent form if the request is a special class. For regular
class, this form is not anymore required.
4. Coordinate with the assigned faculty for the final class schedule before informing those who will join
the class to sign-in at the form. Classes should follow the standard schedule of classes.
5. Discuss with students that if in case the requested class will not meet the required class size,
students will process the Letter with Parents Consent . Inform the students that advanced courses
are not allowed to be opened.
6. Discuss with the students that UPON THE APPROVAL OF THE APPLICATION FOR SPECIAL
CLASS, THOSE WHO SIGNED UP ARE CONSIDERED OFFICIALLY ENROLLED, WILL NOT BE
ALLOWED TO DROP THE SUBJECT AND SHOULD PAY AT THE ACCOUNTING OFFICE. That
any inquiry on this will be directed to the concerned Department/Area/Level Chair.
7. Present the application to the FRD Manager for computation of tuition and other fees based on the
enlisted students.
8. Return the accomplished and approved form to the Office of the Registrar at least a week before the
start of classes for official enrollment of students.
9. Officially inform the Registrar for any change in the number of students, adding or dropping has to be
officially processed.
10. Coordinate with the Registrar any concern that may arise during the course of the study
 DE LA SALLE LIPA
OFFICE OF THE DEPARTMENT / AREA / LEVEL CHAIR
J.P. Laurel National Highway, Lipa City 4217, Batangas, Philippines
Tel. Nos. (043) 756-1849, 756-1887, 756-2391, 756-2491, 757-2011
Fax: (63-43) 981-1781. Official Web Site: http://www.dlsl.edu.ph

The Registrar Date: _______________________

This Institution

Dear Sir:
I would like to request for the inclusion of my son/daughters name in the Special Class Request this
SECOND semester of school year 2013-2014.

I understand that if the minimum class size of 25 students during the regular semester or 15 students for
summer will not be met, my son/daughter and the rest of the students enrolled in this subject will shoulder the
tuition and other fees i.e. the total fees for the subject should be equally divided and appropriately charged to
the enlisted students.

I am aware that my son/daughter is not allowed to drop this subject and payment will be automatically
charged to my sons /daughters account. I am also aware that if he/she will not attend this class, my
son/daughter will be given a failing grade of 5.00 and such will be recorded in his/her Transcript of Records.
My son/daughter has already received his/her latest semesters final course grades and based on this grade
report he has not accumulated 21 units of failure for a 4-year degree program and 26 units for a 5-year
degree program. I am aware that if my son/daughter has exceeded the maximum allowable accumulated
units of failures, he/she will be automatically excluded from the list and will be dismissed by the school.
My son/daughter informed me that he/she has taken the pre-requisite of this subject and that this is part of
his/her maximum load; that he/she will not carry more than what is required of his/her curriculum. In case
there is a need to take this subject as an overload, he/she will seek the approval of the College Registrar
otherwise, he/she will be forced to drop the subject.
My son/daughter will coordinate with the Department / Area / Level Chair for any update on this special class
request including but not limited to tuition and other fees for this subject, payment schedule, class schedules
and room assignments.
That the school has the right to drop my son/daughter from this subject if he/she has found to have violated
any of the rules and regulations of the school on enrollment of special classes.

Conforme:

____________________________________ ______________________________________
STUDENTS SIGNATURE OVER PRINTED NAME PARENTS SIGNATURE OVER PRINTED NAME

Contact Number: _______________________ Contact Number : ________________________

Evaluated and Recommended for Approval: Approved:

ACADEMIC ADVISER DEPARTMENT/AREA/LEVEL CHAIR

SIGNATURE OVER PRINTED NAME CBEAM/CIHTM/CITE/CEAS/CON

Verified and Encoded in the System

ENROLLMENT & EVALUATION IN-CHARGE Date: _________________

This letter will be processed only if the requested class will not meet the required class
size (15 for summer and 25 during the regular semester. Submit this to the assigned
Curriculum and Evaluation In-Charge (Office of the Registrar) at the designated area for
enlistment during the enrollment period.