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Permit To Shift - Transfer-EAMP

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Erica Ann Pineda
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16 views2 pages

Permit To Shift - Transfer-EAMP

Uploaded by

Erica Ann Pineda
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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`

OFFICE OF ADMISSIONS
PERMIT TO SHIFT/TRANSFER

Name of Student: __ _____Erica Ann M. Pineda ________ Sex:_ _Female ___ Age: ____20___ Status: ___Single_

Year level: _____3rd Year____ Semester: _______1st Semester_______ Academic Year: ________2021-2022________

Shifting from: ________BSA________ Shifting to: ___ ____BSAIS_________ Campus: _______Main


Campus_________
(Present Program) (New Program)

Number of times you have SHIFTED course: ____1___ Date Requested:_________08/26/2021_______________


Reasons for shifting: ( Please check )
______ Recommended by adviser ______ Better employment opportunities
 Faster way to graduate ______ Financial concerns (costly cost of course requirements)
______ Parental /peer influence ______ Coping difficulty in _________(specify the course)
______ Failure/s in pre – requisite subjects ______ Other reasons (please specify)

PARENT’S CONSENT: (Affix Signature)

Name of Parent/Guardian: ___________Ana Marie M. Pineda____________ (Attach Photocopy of Parent’s Guardian’s


ID)

Contact No.: ____________09203842673_________________ ______________ _______________


Parent/Guardian Signature

By signing below, I hereby certify that all the information written in this application are complete and accurate. I
agree to update the Office of Admissions and the Registrar’s Office for any changes. I acknowledge
that I have read and understood the Don Honorio Ventura State University (DHVSU) Admissions Privacy Notice posted in the office
premises. I understand that by applying for admission/registering as a student of this university, I allow DHVSU through the
Office of Admissions to collect, record, organize, update or modify, retrieve, consult, utilize, consolidate, block, erase or delete any

(This section is to be filled out by the admission personnel)


information which are a part of my personaRules and Regulationsl data for historical, statistical, research and evaluation purposes
. I also agree, if accepted as a student, that my admission pursuant to the provisions of the Republic Act No. 10173 of the
Philippines, Data Privacy Act of 2012 and its corresponding I, matriculation, legibility for any assistance/grant, and graduation are
subject to the rules and regulations of this institution. mplementi ng

Student’s signature over printed name ________________ERICA ANN M. PINEDA__________________________


Date: ______________26/08/2021________________

[ ] 1st Endorsement [ ] 2nd Endorsement [ ] 3rd Endorsement

DCAT Results: Grade Point Average: _____ Transferee


______ Shiftee
SAI ________________________
STANINE___________________
VI _________________________ Academic Standing based on presented grades:
[ ] Needs Improvement [ ] Below Ave. [ ] Average [ ] Above Ave. [ ] Excellent
(This section is to be filled out by the officials of receiving College )
Remarks: _________________________________

____________

The above mentioned student seeking for admission in your college is hereby endorsed by this office to undergo
qualifying procedures and further evaluation. The applicants’ admission in your college is subject to your
approved retention and promotion policy.

RICHARD N. BRIONES, MAGC, RGC


Director

Recommending Approval:
Program Chairperson

Approved by: Date: _________________________ College Dean


Remarks:

DHVSU-QSP-ADSO-002-FO001-R00

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