GATE PASS

Student’s Name:_____________________________________________________________ Date:_________________

Grade Level & Section:______________________________ Adviser:_________________________________________

Reason(s) :

__________________________________________________________________________________________________

__________________________________________________________________________________________________

_______________________________________________
Signature Over Printed Name of Class Adviser
(Note: Please attach your adviser’s ID for verification and confirmation purposes.)

GATE PASS
Student’s Name:_____________________________________________________________ Date:_________________

Grade Level & Section:______________________________ Adviser:_________________________________________

Reason(s) :

__________________________________________________________________________________________________

__________________________________________________________________________________________________

_______________________________________________
Signature Over Printed Name of Class Adviser
(Note: Please attach your adviser’s ID for verification and confirmation purposes.)

GATE PASS
Student’s Name:_____________________________________________________________ Date:_________________

Grade Level & Section:______________________________ Adviser:_________________________________________

Reason(s) :

__________________________________________________________________________________________________

__________________________________________________________________________________________________

_______________________________________________
Signature Over Printed Name of Class Adviser
(Note: Please attach your adviser’s ID for verification and confirmation purposes.)

GATE PASS
Student’s Name:_____________________________________________________________ Date:_________________

Grade Level & Section:______________________________ Adviser:_________________________________________

Reason(s) :

__________________________________________________________________________________________________

__________________________________________________________________________________________________

_______________________________________________
Signature Over Printed Name of Class Adviser
(Note: Please attach your adviser’s ID for verification and confirmation purposes.)