UNIVERSITY OF THE VISAYAS

Colon St., Cebu City Form

REQUEST FOR CORRECTION OF GRADE(s) FORM

RO-F________

Date : ____JUNE 8, 2021___________

FOR :

FROM :

COLLEGE : _ENGINEERING AND ARCHITECTURE

1st Semester, AY 2018-2019 2nd Semester, AY ___ Summer, Year________

GRADES
ID Number NAME(s) OF STUDENT SUBJECT CODE Offer Code
FROM TO
17020178 RIZZA MAY J. BESAÑEZ AR120 L BLANK 1.3

REASON: LABORATORY SUBJECT WAS NOT INCLUDED IN THE INSTRUCTORS LIST SO IT HAS A BLANK
GRADE.

Attachments:

Department - certified copy of class record(s)

Notarized Faculty Affidavit

Others, please specify :

____________________________________________________________________

Thank you.
Verified & Endorsed by :

FREELI P. BERAME ____

Signature of Faculty over printed name/Date Program coordinator name & signature/Date

Approved by :

_______ ____ _________

Signature of Dean over printed name/Date Signature of Registrar over printed name/ Date

Encoded by :

__________________________________________
Signature over printed name/Date
SMR-RCG.01-7.2020 RLP/ revised 7-23-20

___FREELI P. BERAME__________
Signature over printed name