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: Bachelor of Science in Information Technology b. Graduating
Year and Section: IT 3-2
College of Computer Studies c. Transferring
College:
Academic Year: 2023-2024 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 Sam Cedrick H.
Calites, MM
Neil Richard S. Colada,
LABORATORY/SHOP DIT(CAR)
2 LIBRARY Keanu C. Nido
3 CLINIC Diosa A. Salvador, RN
4 CASHIER Denise An C. Lopez
STUDENT DEVELOPMENT Aldrin B. Boca,
5 SERVICES M Ed CDII
Yves Xavier Candelaria,
6 CLASS ADVISER PhD (Cand)
Richelle E. Go,
7 PROGRAM HEAD PhD (Cand.)
8 DEAN Joy SG. Cruz, PhD
9 REGISTRAR Lorelie G. Anthony
10 CBA Myra M. Salindong
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
