RF-011
April 17, 2023
CLEARANCE FORM
(Graduating Students)
PERSONAL INFORMATION: (Please sign in Print) School Student ID:
LAST NAME FIRST NAME MIDDLE NAME
Section & Track:
Date released: Date submitted:
Students who have completed all the academic requirements may be recommended for graduation even if they have not
processed their clearance. However, the granting of honorable dismissal and the issuance of the transcript / checklist and
diploma shall be withheld pending submission of clearance by the student.
______________________________________ _______________________________________
Parent’s/Guardian’s Signature over printed name Student’s Signature
CLEARANCE
________________________ ________________________ ________________________
Specialized Subject Understanding Culture, Society & Politics Physical Science
________________________ ________________________ ________________________
Physical Education and Health Entrepreneurship Empowerment Technologies
________________________ ________________________ ________________________
Work Immersion/Research/Career Inquiries, Investigation, and Immersion Theology 104
Advocacy / Culminating Activity
________________________ ________________________ ________________________
Guidance Office Canteen Personnel Class President
________________________ ________________________ ________________________
Class Adviser Prefect of Discipline Gatekeeper
________________________ ________________________ ________________________
School Registrar Senior High School Coordinator Senior High School Coordinator
Recommending Approval: Approved by:
____________________________________ ____________________________________
School Principal School Director
Original copy of form must be submitted to the office of the School Registrar.
Guidance Office - unsettled concerns
Canteen Personnel - debts
- utang ukon basi may ara wala mabalik nga gamit sang canteen
Class Adviser - unsettled concerns within the class adviser’s concern
- Balayran sa graduation fee
- Basi wala pa kapalapit iya parent/guardian nga ginpatawag
- Basi wala ga sulod sa klase kag may pending reports
Class President - unsettled concerns within the class president’s concern
- Basi may alamutan sa clase kay wala pa sya ka bayad
- Basi may class project kag wala sya ka participate
Senior High School Coordinator - Basi may concern ang iban nga teachers sa iya nga ginapa
address kay SHS Coor
Prefect of Discipline - Basi may pa disciplinary actions si Prefect nga wala pa niya ma comply
Gatekeeper - Basi e clear sya records sa guard
School Registrar - Basi may mga papers or docs nga wala pa niya ma comply/submit
- ask the help sang bata to ask for their FORM 137 sa previous school
School Principal - RECOMMENDING APPROVAL for clearance
School Director - CLEARED / last to sign