POLYTECHNIC UNIVERSITY OF THE PHILIPPINES

Office of the University Registrar

Sta. Mesa, Manila

EVALUATION RESULT
Date :
Mr. / Ms.

01/26/2015

LOZADA, ANA GABRIELLE LARIOSA

Per evaluation of your scholastic records, you are hereby requested to complete the following requirements in your
chosen courses.
SUBJECT CODE
BRCO 4016

OTHER REQUIRED
CREDENTIALS

NNG

Birth Certificate (NSO Copy)

Form 138/ALS/PEPT
Form 137A
TOR - Copy for PUP (for Transferee)
Shifting Form
NCAE
Others (specify)

Remarks :
This evaluation is tentative, if you still have something to straighten out on oversight or non-inclusion of a subject that you have
taken, please call our attention. Submit this form at the receiving window.
LEGEND :
NAF =
NRC =
NCF =
NNG =

NO ACE FORM
NO REGISTRATION CERTIFICATE
NO COMPLETION FORM
NOT NUMERIC GRADE

SUSAN M. RUEDAS

University Evaluator

Advisory:
1.) If F137A is a deficiency, obtain a copy of the Request for Form 137A Form
- from Student Records Officer at W-116 (For the Sta. Mesa Campus)
- from Ms. Aubree Sanchez at the Campus Registrar's Office (for the San Juan Campus)
2.) (For students in the Sta. Mesa Campus only) If Registration Certificate or ACE Form in any semester/summer is required, submit
a certified photocopy of the required certificate/form of the Colleges copy or the students copy. If no duplicate copy can be
produced, please pay Php150.00 at the University/Campus cashier to claim for a Certification of Official Enrolment in a given
semester/term. After payment, present the original and a photocopy of the Official Receipt to the ARO (Admission and Registration
Office) for the printing of the said certification.
This report is system generated. No signature is required.