Republic of the Philippines

DEPARTMENT OF EDUCATION
Region III
Division of Bataan

_____________________________________
(Laboratory/ Cooperating School)

STUDENT TEACHER’S CLEARANCE FORM

To Whom It May Concern:

This is to certify that Mr/Ms. __________________________, a bonafide Field Study

from Bataan Peninsula State University (Balanga Campus- College of Teacher Education), has
been cleared of any liability (money, property, accountability) as of this date.

This is issued for whatever legal purpose it may serve him/her.

ATTESTED:

_______________________ _______________
Signature over Printed Name Date Signed
Cooperating Teacher

_______________________ _______________
Signature over Printed Name Date Signed
Department Head

_______________________ _______________
Signature over Printed Name Date Signed
School Principal