	DMMC INSTITUTE OF HEALTH SCIENCES Office of the Registrar REGForm01-2011	STUDENT CLEARANCE FORM
		ACADEMIC INFORMATION
		ID Number:
		Course:
Date Received:		GRADUATION	REASON FOR CLEARANCE
PERSONAL INFORMATION		Yes, I graduated on Date:_________________ No, I last attended DMMC IHS on Term _________ S.Y. _______-_______	____ End of Term: 1st/2nd/Summer ____ Graduation ____ File for Transfer Credentials ____ Filing of LOA ____ Dropping ____ Others:_____________________
Lastname:
Firstname:
Middlename:
Maidenname(if married):
Gender:
Birthdate:		SIGNATURE
Citizenship:
CONTACT INFORMATION
Address:		Contact No. (Home):
		Cellphone No:
		Email Address:
CLEARANCE
Please sign if the concerned student is free from responsibility or obligation with your department. Otherwise, specify the reason why we should hold his/her request.
Department	Accountability	Name	Signature	Date Signed
Class Adviser
SHS Principal
Property Custodian
Student Services:
Library
Guidance Office
Clinic
Student Affairs
Student Council
Accounting
Registrar Office

Remarks:________________________________________________________________________________________________________________________________
Note: Please submit fully accomplished clearance to the Registrar's Office.

	DMMC INSTITUTE OF HEALTH SCIENCES Office of the Registrar REGForm01-2011	STUDENT CLEARANCE FORM
		ACADEMIC INFORMATION
		ID Number:
		Course:
Date Received:		GRADUATION	REASON FOR CLEARANCE
PERSONAL INFORMATION		Yes, I graduated on Date:_________________ No, I last attended DMMC IHS on Term _________ S.Y. _______-_______	____ End of Term: 1st/2nd/Summer ____ Graduation ____ File for Transfer Credentials ____ Filing of LOA ____ Dropping ____ Others:_____________________
Lastname:
Firstname:
Middlename:
Maidenname(if married):
Gender:
Birthdate:		SIGNATURE
Citizenship:
CONTACT INFORMATION
Address:		Contact No. (Home):
		Cellphone No:
		Email Address:
CLEARANCE
Please sign if the concerned student is free from responsibility or obligation with your department. Otherwise, specify the reason why we should hold his/her request.
Department	Accountability	Name	Signature	Date Signed
Class Adviser
SHS Principal
Property Custodian
Student Services:
Library
Guidance Office
Clinic
Student Affairs
Student Council
Accounting
Registrar Office