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REG-FO-052 - Requests For Document PDF

This document is a request form for student records from a university registrar's office. It collects the student's personal information like name, address, contact details, academic information like student number, course, and year enrolled. The student checks the type of document needed like diploma, transcript, certificate and its purpose like for employment, enrollment etc. Several offices need to clear and sign the request. The registrar's office notes the special order number and releases the documents. It provides reminders that only the student can request documents, representatives need authorization, and documents can be claimed on Wednesdays or Fridays during specified times.

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Roynard Gadgode Santos
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157 views

REG-FO-052 - Requests For Document PDF

This document is a request form for student records from a university registrar's office. It collects the student's personal information like name, address, contact details, academic information like student number, course, and year enrolled. The student checks the type of document needed like diploma, transcript, certificate and its purpose like for employment, enrollment etc. Several offices need to clear and sign the request. The registrar's office notes the special order number and releases the documents. It provides reminders that only the student can request documents, representatives need authorization, and documents can be claimed on Wednesdays or Fridays during specified times.

Uploaded by

Roynard Gadgode Santos
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 - FO - 052

Revision Status/Date 4 : 20SAug18

DATE FILED: No.


1 ACCOMPLISH THE FORM CORRECTLY REQUEST FOR
INSTRUCTIONS 2 PRINT DATA LEGIBLY IN CAPITAL LETTERS DOCUMENTS
NAME (Family Name, First Name, Middle Name)

PRESENT ADDRESS (No., Street, City/Municipality, Province)

TEL NO. MOBILE NO. GENDER (M/F) BIRTHDATE(MM/DD/YY) BIRTH PLACE NATIONALITY EMAIL ADDRESS

ACADEMIC INFORMATION
STUDENT NO. COURSE / MAJOR YEAR / SEMESTER START (YYYY/SEM) YEAR / SEMESTER END (YYYY/SEM) DATE OF GRADUATION (MONTH/YR.)

TYPE OF DOCUMENT
PLEASE CHECK NO. OF COPIES DOCUMENT PURPOSE
LOCAL FOR BOARD EXAMINATION PURPOSES
AUTHENTICATION
ABROAD (CAV) LOCAL
FOR EMPLOYMENT PURPOSES
CERTIFICATE OF GOOD MORAL CHARACTER ABROAD
CERTIFICATION LOCAL
FOR ENROLLMENT PURPOSES
COURSE DESCRIPTION ABROAD
DIPLOMA FOR SCHOLARSHIP
FORM 137 FOR VISA APPLICATION
HONORABLE DISMISSAL – TRANSFER OTHERS:
CREDENTIALS
TRANSCRIPT OF RECORDS
SECURE CLEARANCE / SIGNATURES FROM THE OFFICES INDICATED
ATHLETICS OFFICE ITRO

COLLEGE DEAN LIBRARY

DISCIPLINE OFFICE OFFICE OF THE STUDENT AFFAIRS

GUIDANCE OFFICE ACCOUNTING OFFICE

INTERNATIONALIZATION OFFICE OTHERS: (if there’s any)

FOR REGISTRAR USE ONLY


SPECIAL ORDER (S.O.) NO. RELEASED BY:
NAME SIGNATURE

REMINDERS
1. Under existing laws, only the owner of the records is allowed to request for documents in connection with his/her school records and claim the requested
douments.
2. Requests and claiming of documents by representative requires authorization letter from the owner. The representative must present his/her two (2) valid
ID’s and one (1) of the owner.
3. Please return this form to the Office of the Registrar after payment at the Accounting Office. Without this form, the request cannot be processed.
4. Claim stub will be needed in order to release the document requested.
5. Initial payment for Transcript of records are two (2) sheets. Additional sheets if needed are to be paid upon the release date.
6. The policy of the University states that once a student has secured his/her transfer credentials, he/she may not be re-admitted in this University.
I have read and understood all the conditions and reminders in connection with this request and agree to comply with them.

SIGNATURE OVER PRINTED NAME DATE


Date Received: Received by:
NAME SIGNATURE

REG-FO-052

DATE FILED: CLAIM STUB No.


This is to acknowledge receipt of your clearance form in connection with your application for:
NAME (Family Name, First Name, Middle Name) Document Requested

Course/Major Date of Follow-up: Date of Release: Released by:


NAME SIGNATURE

REMINDERS: Requested documents may be claimed on either Wednesday or Friday from 1:30 PM to 5:30 PM only.
Call Ms. Mila / Mr. Robert at Telephone Number 749-82-21, 712-19-00 loc. 1212

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