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College of Our Lady of Mercy of Pulilan Foundation Inc.

STUDENT CLEARANCE FORM


STUDENT INFORMATION

Name Student Number


Surname Firstname Middlename

Year Level Course

Semester: School Year:

FACULTY
SUBJECT TEACHER SIGNATURE REMARKS DATE
(Passed, Failed, INC)

ADMINISTRATION
OFFICES Notes (if any) SIGNATURE
Ms. Kassandra Mai Macapagal – School Registrar
(Completed Evaluation)
Mr. Jess Mar RS T. Francisco – Human Resources
Krystal Anne Sibayan – Property Custodian
Leslie Ann Fajardo – Inventory Manager
Reden Bernardo - Finance
Madel Mendoza - School Cashier
Cynthia Vendivil – Prefect of Discipline
Efraim Paez – Office of the Student Affairs
Dr. Rodrigo D. Jimenez – Guidance Counselor
Krystal Anne Sibayan, RL– School Assistant Librarian
Leslie Ann Fajardo, RL – School Assistant Librarian
Ronaldo V. Javier - Clinic

__________________________________
Dean / Program Head / Principal
(Signature over Printed Name)

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