MANILA, PHILIPPINES

WAIVER FORM ____________ Quarter/SY __________________

Name:
Last First Middle Name

Student No. Contact Number(s): STUDENT COMMITMENT ON PRE-REQUISITE COURSE RULE

Program:

Pre-requisite Course

Grade & Status

Date of Completion & Action

Advanced Course

PRE-REQUISITE COURSE WITH INCOMPLETE GRADE

I wish to take the above listed prerequisite and advanced courses. I received a grade of INCOMPLETE (7 or I) for the prerequisite course. I shall assume full responsibility for completing this course on the date stated above as agreed upon between the instructor concerned and me. I understand that the completion of my course should fall within the span of the allowable completion period. I fully understand and agree that should I fail to complete the prerequisite course, I will not receive any credit for the corresponding advanced course in conformity with the regulation on prerequisite courses set by the Commission on Higher Education (CHED).

PRE-REQUISITE AND ADVANCED COURSE TAKEN SIMULTANEOUSLY

I wish to take the above listed prerequisite and advanced courses simultaneously. I fully understand and agree that should I fail to complete the prerequisite course, I will not receive any credit for the corresponding advanced course in conformity with the regulation on prerequisite

Verified by:

Signature Over Printed Name of Student Recommending Approval:

Program Section Chief APPROVED:

DEAN

THE REGISTRAR

RO-018-03