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Academic Year/Term: 20__-20__, ____ Term

University of Santo Tomas


College of Education
3rd Floor, Albertus Magnus Building
España, Manila 1015, PHILIPPINES

CONSULTATION FORM E

Department Department of Elementary Education


Student Full Name
Student ID Number
UST E-mail Address
Year & Section
Name of Course Facilitator
Date & Time of Consultation
 Attendance Progress
 Academic Progress
 Completion of Courses/Units
Reason for Consultation
 Extra-Curricular Activities
 Personal Issues
 Medical Condition/s
 Others: please specify_______________________________________

Details of Consultation

Outcome of Consultation

Student’s Signature _________________________


Signature over Printed Name

Course Facilitator’s/
Supervising Teacher’s
Signature

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