HOLY NAME UNIVERSITY

Tagbilaran City
APPLICATION FOR GRADUATION
[Fill the blanks legibly, use black pen]

Date
The Registrar ID NO:
Holy Name University Gender:
Tagbilaran City Marital Status:
Religion:
Nationality:
Madam:

I have the honor to apply for graduation from the degree / title of
at the end of 1st / 2nd Semester / Summer term, 20
For your information, I submit hereunder the following data:

1. Name

Family Name Name Full Middle Name

Date of Birth Place of Birth
Home Address
Contact Number Email
Father: Mother:
Guardian: (Name, Maiden Name)
Course you are applying for graduation:
Major: Minor:

2. Records of Preliminary Graduation:

Elementary Course Completed:
Name of School:
Primary: (Grade 4) School Year:
Intermediate: (Grade 6) School Year:
High School Course Completed:
Grade 7: School Year:
Grade 8: School Year:
Grade 9: School Year:
Grade 10: School Year:
Grade 11: School Year:
Grade 12: School Year:
3. Subjects you are now taking:

This is to certify that the foregoing entries are true and correct as appearing in my
Scholastic records.

I hereby promise in case of approval of my graduation, to participate in all graduation activities, and to
pay for the required graduation fees.

I also hereby allow Holy Name University to process the data I have furnished herein in connection
with my application for graduation and allow the storage of the same information as part of my
permanent record in the university.

Date Received: Very truly yours,

(Student’s Signature)

DR. VICTORIA C MILLANAR

University Registrar
 Data Privacy Notice

Holy Name University recognizes and respects your right to privacy and the confidentiality of
your personal information. HNU is committed to safe guarding your personal information
pursuant to the provisions of the Data Privacy Act of 2021 (RA 10173). Such information are
acquired, generated, and used for legitimate academic and administrative functions of the
university which also include historical, statistical, research and marketing purposes.

Student’s Consent

In acknowledgement of Holy Name University’s data privacy policy and the Data Privacy Act of
2021 (RA 10173), I willfully give my consent to Holy Name University to collect, store, process
and use my personal and private information and associated data that may be generated for its
legitimate academic and administrative functions and related purposes.

(Student) Signature over Printed Name/Date