Republic of the Philippines

DEPARTMENT OF EDUCATION


PUPILS CLEARANCE FORM
S.Y.2011-2012


Name:___________________________________ Teacher:____________________________
Grade and Section:_________________________ Date:_______________________________


SUBJECTS
Teachers Signatures
BOOKS NOTEBOOKS PROJECTS
1.English
Language
Reading
2.Filipino
Wika
Pagbasa
3.Mathematics
4.Science and Health
5.HEKASI
6.EPP
7.MSEP
8.Values Education



COLLECTIONS SIGNATURES
1.Authorized Collections
2.Class Funds
3.Garland Fee
4.Graduation Fee
5.Homeroom Projects
6.others:



SPECIAL PROJECTS SIGNATURES
1.Husks
2.Tambo
3.Stick Brooms
4.Rags
5.Plants in pots/cans

____________________________________
Pupils Signature


Clearance Recommended:

______________________________
Adviser


Clearance Granted: