APPLICATION FOR GRADUATING COLLEGE STUDENT'S CLEARANCE

Date/time of printing May 09, 2019 10:28 AM

ID No. 151069 Name of Student CO, JOHN RAYNER WONG
Degree & Concentration BS MGT
Date of Graduation ___________________ Contact number ___________________
 
This form is for the student whose name appears above and is non-transferrable.

Any unauthorized photocopying of this form or misrepresentation of data shall be subject to disciplinary action and exclusion
from the graduation list.

Offenses/violations/liabilities committed after submission of clearance form will also prevent graduation.
 
_______________________
Signature of Student

ENDORSEMENTS: Secure signatures in any order and submit completed form to the Office of the Registrar

 [CLEARED; NO SIGNATURE/APPROVAL REQUIRED]

 [CLEARED; NO SIGNATURE/APPROVAL REQUIRED]
6. Director, Office of Student Activities
1. Department Chair/Program Director  Name in Print & Signature Name in Print & Signature
   

 [CLEARED; NO SIGNATURE/APPROVAL REQUIRED]  [CLEARED; NO SIGNATURE/APPROVAL REQUIRED]

2. Director, Rizal Library 7. Director, Office of Guidance and Counseling

Name in Print & Signature Name in Print & Signature
   

 [CLEARED; NO SIGNATURE/APPROVAL REQUIRED]  [CLEARED; NO SIGNATURE/APPROVAL REQUIRED]

3. Director, Office for Student Services 8. Director, Residence Halls

Name in Print & Signature Name in Print & Signature
   

 [CLEARED; NO SIGNATURE/APPROVAL REQUIRED]

 [CLEARED; NO SIGNATURE/APPROVAL REQUIRED]
4. Coordinator for Student Discipline 9. Cashier
Name in Print & Signature Name in Print & Signature
   

 [CLEARED; NO SIGNATURE/APPROVAL REQUIRED]  [CLEARED; NO SIGNATURE/APPROVAL REQUIRED]

5. Director, Office of Admission and Aid 10. Director, Central Accounting Office
Name in Print & Signature Name in Print & Signature

School Registrar: __________________________ Date: ____________________

 REQUEST FOR OFFICIAL DOCUMENTS
Date Requested: __________________ Date Due: __________________
ID No. 151069    Name of Student CO, JOHN RAYNER WONG
Degree & Concentration BS MGT
 
Two (2) Paid Transcripts For Evaluation   For Employment  
  Fee/Amount Paid: ___________
(DCB-WExpress 105-078-004) __________     O.R. No.: __________________
Mailing Fee (local only)
  (DCB-DHL 105-078-005) __________     Cashier: _________
   Addressee ___________________________________________________________ Contact No: ___________________
   Mailing Address _______________________________________________________
                              _______________________________________________________
Transcript Clerk: __________________  

NOTES:
Two (2) copies of Transcripts of Records have been paid with tuition payment. Check the purpose to be indicated in the transcripts (i.e. for evaluation,
for employment).
Students who wish to have their documents sent to them via courier (local only) must pay the mailing fee. The mailing address and contact number must
be indicated above.
Representatives must present an AUTHORIZATION LETTER, valid Government I.D. cards (of owner & representative) to claim documents.
Document/s not claimed after 90 DAYS from due date will be DESTROYED and payments made FORFEITED.
For cash Payment, pay only at the CASHIER; Cashier office hours: Monday-Friday: 8AM-12NN; 1PM-4 PM, Saturday: 8AM-12NN

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