Republic of the Philippines

Laguna State Polytechnic University

Province of Laguna

College of ______________________

SLIP FORM

Date:
To:

This is to
(State your Purpose, include
date, time…. etc)

(State your Reason)

(Signature over printed name of Faculty)

(Designation)
ACTION TAKEN:

[ ] Approved as requested

[ ] Approved with provision

[ ] Denied

(In-
charge)

This Form shall be filled up by a Faculty who wants to notify/ request/ inform the Office of possible
change in his/her Classroom Activities (e.g. holding advance class or make-up class, change classroom,
out-campus activity, thesis defense…etc); being absent, or going out of the campus while still on official
time. It serves as a proof of your whereabouts in instances of monitoring. It must be submitted before the
actual time of incidence.

LSPU-ACAD-SF-012 Rev. 0 10 August

2016
LSPU-ACAD-SF-012 Rev. 0 10 August
2016