CLEARANCE FORM

FOR OUTGOING OFFICER

This Clearance Form should be signed by each Department listed below on or before the officer’s last
working day. Please indicate in the accountability column “N/A” or “NONE” if the outgoing Student
Leader has no accountability (as a Student Leader or part of an organization). The Student Activities
and Development Unit (SADU) should be the final stop for clearance and submission of the form.

NAME:
DESIGNATION:
OFFICE / UNIT ACCOUNTABILITY SIGNATURE / DATE

1. Executive Director’s Office

2. Computer Laboratory &

Management Information Center

3. Library

4. Communication’s Office

5. Computer Laboratory &

Management Information Center

6. Discipline Unit

7. Facilities Office

8. Industry-Academe Linkage,
Alumni & Placement Office
9. Director of the Department /
Office

10. Registrar’s Office

11. Guidance Unit

12. Community Extension Services

Unit

13. Adviser of the Organization

14. President of the Organization

15.Student Activities and

Development Unit
ORGANIZATION:

FO-ACSERV-SADU-060/08OCT2018/REV.0