GRADUATION CLEARANCE FORM (Tertiary)

PERSONAL INFORMATION

Student No. Academic Program

Last Name Full Name Middle Name Suffix Name

Birth date Place of Birth

Gender Telephone No.

Civil Status Mobile No.

Citizenship Email Address

Current Address

Provincial Address

CLEARANCE FORM

DEPARTMENT SPECIFIC ACCOUNTABILITIES STATUS CLEARED BY DATE

I-cares Registration / STIAA Meyc

Guidance Office
OEPS (eLMS) / Job Fair

Tuition fee
Cashier
Graduation Fee

Dean’s Office Academic Requirements

Entrance Requirements (Admission Office)

Registrar’s Office
/Admission Office Student grades/checklist

PLEASE PRESENT THIS FORM IN CLAIMING YOUR TOGA