Republic of the Philippines

ANTIPOLO CITY GOVERNMENT

Province of Rizal

STUDENT ASSISTANCE PROGRAM

(Iskolar Ng Antipolo)
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Name of College/University
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Address
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Date

CERTIFICATE OF ENROLLMENT AND BILLING

Student Name: ___________________________________________________ Gender: ______________
Course: ______________________________________________________________________________
Year Level:
1st ___________ 2nd ___________ 3rd ____________ 4th ___________ 5th ____________
School Year: ________________________ Semester: 1st _________ 2nd ____________ 3rd ___________

SUBJECTS

UNITS

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Total Units
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A. Tution

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B. Miscellaneous

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C. Laboratory

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D. Library

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E. Medical/Dental

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F. Others

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ASSESSMENT
P

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Amount Payable

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Signature of Student-Grantee
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Registrar
Head

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College Dean/ College