Clearance Form

This is to certify that Mr./Miss of

(Name of Student)

has been cleared from any requirements,

(Name of Institution)

obligations, and accountabilities during his/her Field Study and Teaching Assistantship in the

(Cooperating School)

Date: .

(Printed name and Signature of Cooperating Teacher)

Date: .

(Printed name and Signature of Cooperating Teacher)

Date: .

(Printed name and Signature of Cooperating Teacher)

(Printed name and Signature of School head)