Technological University of the Philippines

COLLEGE OF INDUSTRIAL TECHNOLOGY

Electrical Engineering Technology Department
Ayala Boulevard, Manila

(Date)
CLEARANCE FORM

Name: Course, Year and Section:

Student No: Last Enrollment:
Date Graduated: mm/yyyy
mm/yyyy

Project Title:

By initialing below, I certify that has complied

with all the requirements and is cleared from financial accountabilities.

Name Signature
Department Head
(Prototype was tested and submitted to the
department/was extended to the
beneficiary and thesis was submitted)
Thesis Adviser
(copy of thesis was provided)
Group Leader
(financial contribution was payed)
Groupmate
Groupmate
Groupmate
Groupmate
Other (Pls. indicate)