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Students' Clearance Form: Campus: Angono

This document is a student clearance form used by the University of Rizal System. It requires students to get signatures from various campus departments and offices to confirm there are no outstanding obligations before transferring schools, graduating, or other activities. Signatures are needed from the laboratory, library, cashier, student services, class adviser, program head, dean, and registrar. Instructions are provided on the back to guide students and staff on the clearance process.

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Jomarie Paclibar
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115 views2 pages

Students' Clearance Form: Campus: Angono

This document is a student clearance form used by the University of Rizal System. It requires students to get signatures from various campus departments and offices to confirm there are no outstanding obligations before transferring schools, graduating, or other activities. Signatures are needed from the laboratory, library, cashier, student services, class adviser, program head, dean, and registrar. Instructions are provided on the back to guide students and staff on the clearance process.

Uploaded by

Jomarie Paclibar
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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REG OFC FORM: _____

COLLEGE LEVEL Republic of the Philippines


GRADUATE SCHOOL
UNIVERSITY OF RIZAL SYSTEM
Province of Rizal

OFFICE OF THE REGISTRAR


STUDENTS’ CLEARANCE FORM

Campus: Angono Antipolo Binangonan Cainta Cardona

Morong Pililla Rodriguez Tanay Taytay

COLLEGE LEVEL GRADUATE SCHOOL


Name of the Student:
Last Name First Name Middle Name Reason for Clearance
Student Number:
Contact Number: a. Enrolling
Course/Major: b. Graduating
Year and Section:
c. Transferring
College:
Academic Year: d. Others
First Sem. Second Sem. Summer ________________
Academic Year Last Attended
(for old student returnee)_______________________________________________

CLEARING
NO. DEPARTMENT SIGNATURE DATE REMARKS
OFFICER
1 LABORATORY/SHOP

2 LIBRARY

3 CASHIER

4 STUDENT DEVELOPMENT
SERVICES

5 CLASS ADVISER

6 PROGRAM HEAD
7 DEAN
8 REGISTRAR
NMTC

____________________________________
STUDENT’S SIGNATURE OVER PRINTED NAME

(In accomplishing the clearance, please be guided by the instructions at the back.)

URS-AA-RG-F-2017-06 Rev. 00 Effectivity Date: August 15, 2017


INSTRUCTIONS:
1. Secure Student’s Clearance Form at the Registrar’s Office.
2. Laboratory/Shop in-charge clears the student of accountabilities in terms of utilization of
equipment/tools. The laboratory/shop pertained to here are the following: Computer/ICT.
Typing, Science, HRM, Fish-Processing.
3. Librarian clears the student of accountabilities in terms of book/s or any other library’s
information material/s.
4. Cashier clears the student of any financial obligation.
5. Office of Student Development Services clears the student on matters that concern the
different units namely Discipline, Guidance and Scholarship, as well as the different
student organizations.
6. Class Adviser clears the student of accountabilities concerning classroom maintenance; the
class adviser coordinates with the different subject instructors if there are other concerns
that need to be settled
7. Program Head checks whether the student has subjected himself to evaluation in the
previous semester (enrolment purposes) to ensure that all units required for the program
have been met; for graduating, whether the academic requirements have been completed.
8. Office of the Dean clears the student upon confirmation with the Program Head as to the
fulfillment of the academic requirements.
9. Registrar checks the form for complete clearance by other relevant departments.
10. This clearance shall be presented to the enrolling officer during enrolment or when
claiming for transfer credential, Transcript of Records (TOR), diploma and other
certification.

Note: The student needs first to write in full the names of their respective class adviser,
program head, and college dean before requesting for their signatures.

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