Certificate of Emancipation From Parents Foreign Students

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Date: 31/08/2022

DR. JOHDEL C. CABALUNA, RN, RM, LPT, MAN


Dean,School of Nursing
Panpacific University
Urdaneta, Pangasinan

Respected Sir,

I, IBRAHIM,QOSSAY BM a bonafide student of Panpacific University, enrolled


in the School of Nursing (Level 4) , a Palestinian (Nationality) respectfully
request that I would be allowed to sign the waiver for the clinical rotation. I
request this for one of the following reasons (place a check mark beside that
apply)

I am of legal age

I am legally emancipated from my parent/s.

Respectfully yours,

Signature over Printed Name of student

IBRAHIM,QOSSAY BM

+6375-632-7278
MacArthur Highway, San Vicente,
secretariat@panpacificu.edu.ph
Urdaneta City, 2428 Philippines
www.panpacificu.edu.ph
+6375-632-7278
MacArthur Highway, San Vicente,
secretariat@panpacificu.edu.ph
Urdaneta City, 2428 Philippines
www.panpacificu.edu.ph

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