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PUP Completion Form R-1

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raejinchoi1
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34 views2 pages

PUP Completion Form R-1

Uploaded by

raejinchoi1
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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CONTROL NO.

: ______________________
REPUBLIC OF THE PHILIPPINES APPLICATION FOR
POLYTECHNIC UNIVERSITY OF THE PHILIPPINES LATE REPORTING OF GRADE
OFFICE OF THE UNIVERSITY REGISTRAR (Please attach certified photocopy of class record and Official Receipt)
STUDENT RECORDS SERVICES COMPLETION OF "INCOMPLETE GRADES"
STA. MESA, MANILA (Please attach photocopy of Official Receipt)
CORRECTION OF ENTRY
(Please attach certified photocopy of class record & Affidavit of Change of Grade)
Others

DATE: ____________________

The Dean
College of: ___________________________________________________

I hereby request that

Student Number: ___________________________ Name: ___________________________________________________________


(Example: 2010-000001-MN-0) (Last Name) (First Name) (Middle Name)

Course: __________________________________Year & Section: ________________________________________


Subject Code: ___________________________________ Subject Title: ________________________________________
School Year: ___________________________________Term: First Semester
School Session: Day Second Semester
Night Summer Campus: __________________

which was reported as:


_________________________________________________________________________________________________
_________________________________________________________________________________________________
due to the following reason/s:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
be credited as one:
who has "NO GRADE" in the Grade Sheets to a final grade of ______________________ ______________ units.
who has completed all the requirements with a final grade of ______________________ ______________ units.

GRADE: First Grading : _______________


Second Grading: ____________Final Grade : _______________
whose name in the Grade Sheet be corrected
From: _____________________________________________________________________________________
(Last Name) (First Name) (Middle Name)

To: _____________________________________________________________________________________
(Last Name) (First Name) (Middle Name)

Others, specify:
___________________________________________________________________________________________
___________________________________________________________________________________________

Thank you.
___________________________________________________
PROFESSOR/INSTRUCTOR
(Signature over Printed Name)

APPROVED BY DEAN/CHAIRPERSON
Name: _____________________________________________Signature: __________________________Date: _____________

Received by Office of the Student Records, University Registrar

Name: _____________________________________________Signature: __________________________Date: _____________

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