University of the East

Law Recto
College Campus

APPLICATION FOR REMOVAL OF “LFR” MARK

All personal information provided in this request form will be held and treated with confidentiality and will only be used for the purpose for which it was
given. By signing this form, you are certifying that all provided information are true and correct and likewise authorizing your College to process your
information. Your accomplished form will be kept in a secure place and will be disposed of after one year.

TO BE FILLED-OUT BY THE STUDENT

For the Dean
I would like to apply for and request your approval
(Place a check mark [✓] in the appropriate bracket.)
[✓] to complete my PRESCRIBED REQUIREMENTS in
[ ] to take a SPECIAL EXAMINATION in
SUBJECT STUDENT’S INFORMATION
SUBJECT CODE LTW 499 (1499) SURNAME ONG
SECTION III-A-1 GIVEN NAME MIKHAEL
DAY & TIME MIDDLE INITIAL G
TERM STUDENT NUMBER (S.N.) 2015-0173425
[✓] 1 Semester
st
[ ] 2 Semester
nd
[ ] Summer PROGRAM – MAJOR JD

SCHOOL YEAR 2017-2018 SIGNATURE

(Place your e-signature here.)
TEACHER’S NAME
SURNAME DALISAY DATE of Filing the Application
01/06/2021
GIVEN NAME JOSE Form (MM/DD/YYYY)
MIDDLE INITIAL Y.

TO BE FILLED-OUT BY THE TEACHER

This is to certify that Mr. / Ms. with S.N. was my student in

the subject and section indicated above and that he/she was given an “LFR” mark because of the following reason/s:

His / Her grades were:

PRELIM MIDTERM

% Grade % Grade
% Grade in words % Grade in words
Eqv. Pt. Eqv. Pt.
Eqv. Pt in words Eqv. Pt in words
[ ] The prescribed requirement/s was/were submitted on (MM/DD/YYYY)
[ ] A special examination was given on (MM/DD/YYYY) and administered by :

Given Name Middle Surname

Initial

In view of this, his/her FINAL GRADE is follows:

FINAL GRADE TEACHER’S CONFIRMATION
% Grade Signed:
% Grade in words
Given Name Middle Surname
Eqv. Pt. Initial
Eqv. Pt in words SIGNATURE
(Place your e-signature here.)

DATE SIGNED (MM/DD/YYYY)

ACTION OF THE DEAN

[ ] Approved [ ] Disapproved

Middle Surname
Given Name
Initial

REMARKS:

SIGNATURE
(Place your e-signature here.)

DATE SIGNED (MM/DD/YYYY)

DISTRIBUTION AFTER ACCOUNT VERIFICATION: 1 copy (DEAN), 1 copy (DRRM), 1 copy (STUDENT), 1 copy (FACULTY)
 FLOW CHART FOR THE ONLINE APPLICATION FOR THE REMOVAL OF AN LFR MARK

The movement of information from one entity to another will be through the official UE email account.

Student downloads the electronic copy of the Application Form for Removal of an LFR Mark from the
Student Portal and fills out the required information.

Student pays the application fee through GCash or designated online banking facilities.

Student sends the accomplished form to the Dean together with the
his proof of payment for the application.

The Dean, through the Department Chairperson, advises the faculty member concerned regarding the
student’s application for proper action.
Faculty member will be advised to communicate with the student and facilitate necessary activities to
process the application.
If the faculty member is no longer connected with the University, the Department Chairperson will
communicate with the student and facilitate necessary activities to process the application.
Faculty member/Department Chairperson provides the mechanism for the student to take a removal
examination or accomplish the prescribed final requirement as indicated in the class record.

Faculty member/Department Chairperson sends to the Dean the completed Application form for
Removal of an LFR Mark and the corrected examination paper or final requirement within five (5) calendar
days.

The Dean sends to the Comptroller’s Department the signed application form in .pdf format and the
student’s proof of payment to the Cashier.

The Cashier sends the official receipt to the student and informs the Comptroller’s Department of this
status.

The Comptroller’s Department validates the student’s account and sends copy of the verified application
form to the following: 1 copy (DEAN), 1 copy (DRRM), 1 copy (STUDENT), 1 copy (FACULTY).