STUDENT CLEARANCE FORM

FOR STUDENT USE

Student Name: NATIVIDAD, MIAMOR D. Course: JD Major: NA
Home Address: BRGY. BINONGTO-AN, TANAUAN, LEYTE Term & Year Graduated: 2ndAY 2020
Telephone: NONE Mobile: 09203987423 E-mail: miamordnatividad@yahoo.com
Note to the Student:
Upon completion of your course, you must obtain a signature from departments indicated below for clearing of all your
obligations in School. It is the responsibility of the student to check with the SPSPS Departments listed and to obtain a final
clearance before leaving Saint Paul School of Professional Studies.
FOR OFFICIAL USE
Librarian:
It is confirmed that the student has no obligations regarding borrowed books and other library resources.

Name: Signature: Date: / /

Student Personnel Services Office:
It is confirmed that nothing is pending against the mentioned student.

Name: Signature: Date: / /

School Accountant:
It is confirmed that all financial obligations of the student has been settled.

Name: Signature: Date: / /

Subject/s and Professor/s during the terminal semester:
Subjects Professor’s Signature Subjects Professor’s Signature
and Student’s Grade and Student’s Grade

Department Chair:
It is confirmed with the faculty that the student passed in all subjects taken during the terminal semester.

Name: Signature: Date: / /

Dean:
It is confirmed that the student has completed all academic requirements for his/her course.

Name: Signature: Date: / /

Registrar:
It is confirmed that the mentioned student has submitted all the necessary documents required for graduation.

Name: Signature: Date: / /

TO BE ACCOMPLISHED BY THE STUDENT UPON RECEIPT OF CREDENTIALS FROM SPSPS.
Student Pledge:
It is confirmed that I received all the official/original documents (diploma, transcript & certificates) from SPSPS.

Name: Signature: Date: / /

Note:
1. Accomplish this form in two (2) copies.
2. The completed form must be returned to the Office of the Registrar.