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  • Student's Clearance - University

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    Eurica Castillo
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    The document is a student clearance form from a university requesting various documents. It collects the student's personal information and academic details. It lists items that can be requested, including an honorable dismissal, transcript of records, diploma, and certification. University officials must sign to clear the student of any financial obligations before the items can be released.

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    Student's Clearance_university

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    The document is a student clearance form from a university requesting various documents. It collects the student's personal information and academic details. It lists items that can be requested, including an honorable dismissal, transcript of records, diploma, and certification. University officials must sign to clear the student of any financial obligations before the items can be released.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as docx, pdf, or txt
    28 views1 page

    Student's Clearance - University

    Uploaded by

    Eurica Castillo
    The document is a student clearance form from a university requesting various documents. It collects the student's personal information and academic details. It lists items that can be requested, including an honorable dismissal, transcript of records, diploma, and certification. University officials must sign to clear the student of any financial obligations before the items can be released.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as docx, pdf, or txt
    of 1

    STUDENT‘S CLEARANCE

    Student’s No.: _____________


    NAME: ________________________________________ Address : ____________________________________
    (Pls print) Surname F. Name M. Name Date Filed: ______________O.R. No. : ____________
    Date Admitted in BulSU:__________________________ have you requested for any of the item below
    Course/Major/Section in BulSU: ____________________ previously?_______________ If yes, please specify
    H.S. where graduated: ____________________________ ____________________________________________
    Did you transfer to BulSU? _______If yes, please indicate Last Term in BulSU: __________________________
    The school you came from: ________________________ Purpose of Request: __________________________
    No. of terms in BulSU: Sem/Tri/Sum: _______________ Contact No.: _________________________________
    Total No. of Units earned: ________________________ Birthday: ___________________________________

    CHECK THE REQUESTED ITEM (S) BELOW:


    -------------------------------------------------------------------------------
    ______1. Honorable Dismissal ______4. Certification
    ______2. Transcript of Records ______5. Others, please specify
    ______3. Diploma
    _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
    THE ABOVE STUDENT IS CLEARED OF ALL MONEY AND PROPERTY ACCOUNTABILITIES IN MY
    OFFICE

    (To be signed by the responsible officials concerned)


    _____________________________________________________________

    Faculty Adviser: ________________________________ Dean: ______________________________________

    Librarian:_______________ Dean of Student Affairs ________________ In-charge, Accounting______________

    APPROVED:

    ALBERT B. VILLENA
    Registrar IV
    _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _
    (SLIP for the student)

    TO: ________________________________________________________________________________________
    NAME Course/Year/Section/Major

    Your _____________________________________will be released on ____________________________

    ***IMPORTANT***
    An AUTHORIZATION LETTER, ID of STUDENT AND ID of REPRESENTATIVE must be presented if
    subject student is not available to receive the requested document on the scheduled date of release.

    BulSU-OP-OUR-02F2
    Revision: 0

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