Revised 2018 | Registrar's copy
APPLICATION FOR GRADUATION
*For First Sem AY 2019-2020 Application Code: 14q65616
Student Number: 14-5616 Date: September 09, 2019
CORPUZ MARK LOWIE B. BATUGO
Last Name First Name Middle Name
COE BS in Electronics Engineering September 23, 1997
College Degree Date of Birth
MMMH-BATAC CITY Male 09179544684
Place of Birth Gender Contact Number
NONE, BGY NO. 18 SAN PEDRO (BINGAO), SAN NICOLAS, ILOCOS NORTE, PHILIPPINES
Home Address
RECORD OF PRE-UNIVERSITY EDUCATION
Name of School Year Graduated
Elementary : BINGAO ELEMENTARY SCHOOL 2010
Secondary : SAN NICOLAS NATIONAL HIGH SCHOOL 2014
Were you a TRANFEREE/SHIFTEE/CROSS ENROLEE? NO
Qualified as HONOR STUDENT as of Mid Year, Fourth/Fifth Year? NO
Noted:
_________________________________ _________________________________
Student's Signature Adviser
O.R. # __________________________________
Date __________________________________ _________________________________
Department Chair
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Revised 2018 | Dean's copy
APPLICATION FOR GRADUATION
*For First Sem AY 2019-2020 Application Code: 14q65616
Student Number: 14-5616 Date: September 09, 2019
CORPUZ MARK LOWIE B. BATUGO
Last Name First Name Middle Name
COE BS in Electronics Engineering September 23, 1997
College Degree Date of Birth
MMMH-BATAC CITY Male 09179544684
Place of Birth Gender Contact Number
NONE, BGY NO. 18 SAN PEDRO (BINGAO), SAN NICOLAS, ILOCOS NORTE, PHILIPPINES
Home Address
RECORD OF PRE-UNIVERSITY EDUCATION
Name of School Year Graduated
Elementary : BINGAO ELEMENTARY SCHOOL 2010
Secondary : SAN NICOLAS NATIONAL HIGH SCHOOL 2014
Were you a TRANFEREE/SHIFTEE/CROSS ENROLEE? NO
Qualified as HONOR STUDENT as of Mid Year, Fourth/Fifth Year? NO
Noted:
_________________________________ _________________________________
Student's Signature Adviser
O.R. # __________________________________
Date __________________________________ _________________________________
Department Chair
Procedure:
1. Request your Adviser and Department Chair to sign this form.
2. Pay graduation fee at the Cashier's Office.
3. Submit this form to the Registrar's Office together with your NSO Birth Certificate original or xerox and 2"x2" ID picture with royal blue
background and name tag.