OFFICE OF THE UNIVERSITY REGISTRAR

1/F Administration Building

Visca, Baybay City, Leyte, 6521-A PHILIPPINES
Telefax: +63 53 563 7067 or 565 0600; Local 1010
Email: registrar@vsu.edu.ph
Website: www.vsu.edu.ph

APPLICATION FOR GRADUATION FORM

_______________ Application Fee P

Date Official Receipt Number
Date
The University Registrar Checked by
Visayas State University Enrolment List (EL) Checked:
Visca, Baybay City, Leyte 6521-A [ ] Enrolled
[ ] Not enrolled
Checked by
Through: The Dean
College of_________________
/Graduate School Dean Other requirements for graduation:
Sir/Madam:
[ ] Approval Sheet of manuscript
I have the honor to apply for graduation as of [ ] Approved Transmittal of manuscript
[ ] Three(3) copies of latest picture(2x2,
for the degree of colored with white background)
major in . [ ] Birth Certificate from PSA
[ ]Tree Planting Certificate
[ ] Clearance
Very Truly Yours,

Printed Name and Signature of Applicant Student Number

Cell phone Number Telephone Email Address

A. Title of [ ] Thesis [ ] Case Study [ ] Special Problem [ ] Field Practice [ ] Narrative Report

B. Secure approval from your Thesis/Case Study/Special Problem/

Field Practice/ Narrative Report Adviser.
Printed Name and Signature of Thesis/SC/SP/FP/NR Adviser
C. Subject(s) enrolled this (current) semester:

Course Number and Description Units Course Number and Description Units

D. Subjects with INC grades, GNS, not yet taken or to be enrolled next term (to be filled by the course in-charge)
Course Number and Description Units

Approved:

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Vision: A globally competitive university for science, technology, and environmental conservation.
College Dean/Graduate School Dean cutting-edge scientific knowledge FM-REG-24
Mission: Development of a highly competitive human resource,
v1 06-30-2020
and innovative technologies for sustainable communities and environment.
No.
E. Secure Approval from your College Dean/Graduate School Dean

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Vision: A globally competitive university for science, technology, and environmental conservation.
FM-REG-24
Mission: Development of a highly competitive human resource, cutting-edge scientific knowledge
v1 06-30-2020
and innovative technologies for sustainable communities and environment.
No.
 PERSONAL DATA SHEET OF APPLICANT FOR GRADUATION
(Please print all entries in capital letter)

Student Number:

Name:
Family Name First Name Middle Name
If you are a married woman, write your maiden name:

Age: Sex: Religion: Citizenship:

Date of Birth: Place of Birth: Civil Status:

Home Address:
Barangay/Street Town/City Province
Name of Father: Citizenship: Occupation:

Name of Mother: Citizenship: Occupation:

Parent’s Address:

If Married, Spouse(husband/wife) Name: Occupation:

Spouse Address:

SCHOOL RECORDS
Honors or
School
Name of School Address of School Distinctions
Year
Received
Intermediate
Secondary
Tertiary: 1st Year
2nd Year
3rd Year
4th Year
5th Year
6th Year

Graduate Education (for Graduate Students only)

Membership in Organizations:

I swear that all entries contained in this application for graduation are true and correct to the best of my knowledge
and belief.

Signature of Applicant Date

Page 3 of 4
Vision: A globally competitive university for science, technology, and environmental conservation.
FM-REG-24
Mission: Development of a highly competitive human resource, cutting-edge scientific knowledge
v1 06-30-2020
and innovative technologies for sustainable communities and environment.
No.
Distribution of copies: 1-College Dean and 1-University Registrar

Page 4 of 4
Vision: A globally competitive university for science, technology, and environmental conservation.
FM-REG-24
Mission: Development of a highly competitive human resource, cutting-edge scientific knowledge
v1 06-30-2020
and innovative technologies for sustainable communities and environment.
No.