Casiciaco Recoletos Seminary, Inc.

FORM 6A
OFFICE OF THE REGISTRAR

CLEARANCE FORM
APPLICATION PROCEDURE FOR COLLEGE
(TO REQUEST ANY CRENDENTIAL)

STEP 1: Kindly fill up legibly all the REQUIRED information:

PERSONAL INFORMATION

Last Name: ______________________ First Name: _____________________________ Middle Name: ______________

Birthdate (mm/dd/yyyy): _ _/_ _/_ _ _ _ Birthplace: _____________________________ ID Number: _______________
Nationality: ______________________

ACADEMIC INFORMATION CONTACT INFORMATION

Currently enrolled: Old student: Tel No w/ Area code: ___________________________________
Mobile No.:___________________________________________
Course/Degree: ________________________________________ Email Address: ________________________________________
Permanent Address: ____________________________________
Graduated: Yes Year Graduated: _______________________ _____________________________________________________
No Year Last attended: ____________________

CREDENTIALS APPLIED FOR PURPOSE

Original Transcript of Record P200.00 Transfer to another school
Transfer Credential/Honorable Dismissal 150.00 School: _______________________________
Diploma 1,500.00 Reason: ______________________________
Duplicate Diploma (to provide Affidavit) 1,500.00 Board Exam
Certificate of Graduation 175.00 Evaluation
Certified photocopy of Transcript/Diploma 50.00/page Abroad
Certified photocopy of F-138/SF9 F-137a/SF10 50.00 Employment
Certificate of Enrolment / Units earned 75.00 Others: _______________________________
Copy of Final Grades Term: _____________ 50.00
Certificate of English as a Medium of Instruction 75.00 By my signature below, I hereby give my consent to CaReS’ collection, processing &
Certificate of GWA 100.00 storage of the above information pursuant to the provisions of the Republic Act No.
Certificate of GMC 150.00 10173 or the Data Privacy Act of 2012.
Others: _____________________ (for CHED CAV/Authenticated TOR and Diploma pls call the office)

_______________________________________________ _________________________________________________
Printed Name & Signature of Authorized Representative Signature of Student Applicant

STEP 2: Please proceed to the Offices listed below for clearance.

Registrar’s Office: ________________________________________ ___________

Cleared from Registrar’s Office Responsibilities Date
Office of the Library: ______________________________________ ___________
Cleared from Library Responsibilities Date
Office of the Prefect: _____________________________________ ___________
Cleared from Prefect’s Responsibilities Date
Office of the Procurator: ___________________________________ ___________
Cleared from Procurator’s Responsibilities Date

STEP 3. Please present this form to the REGISTRAR’S OFFICE for Assessment of Fees.

Transcript Fee ______________________ No. of Pages: ________________________ P ____________________________

Certified Photocopy of Transcript ______ No. of Pages: ________________________ P ____________________________
Other Certificates ___________________ No. of Pages: ________________________ P ____________________________
Diploma Fee ________________________________________________________________ P ____________________________
Mailing Fee ________________________________________________________________ P ____________________________
Others (please specify)________________________________________________________ P ____________________________
Total: ____________________________

STEP 4. Please proceed to PROCURATOR’S OFFICE for the payment of necessary fees.

School Accounts cleared as of: ___________________ ______________________ ___________

Date Cashier OR #

STEP 5. After payment of fees, kindly return this form to the Registrar’s Office for preparation of requested credential/s.

THIS CLEARANCE IS VALID FOR ONE (1) MONTH ONLY UPON THE DATE OF ISSUANCE.

PEASE READ THE IMPORTANT INFORMATION AT THE BACK

 Casiciaco Recoletos Seminary, Inc. FORM 6A
OFFICE OF THE REGISTRAR

IMPORTANT INFORMATION

1. Students/Alumni/Former Seminarians who cannot personally claim their credentials should prepare an “Authorization Letter.”
Please attach a photocopy of valid ID of the owner of the document/s and the authorized representative.
2. Seminary policy provides that no school credential shall be released unless the student/alumnus/former seminarian is cleared of
all office financial obligations.
3. All school credential requests shall be released at least within15 working days after the payment of fees to enable the Registrar’s
Office to prepare said credentials.
4. The Official Transcript of Records of transferring students/seminarians shall be sent by the Registrar’s Office through mail to the
school where the student transferred upon receipt of request from said school.
5. The release of a student’s/seminarian’s transfer credential/honorable dismissal and transcript of records shall be considered as his
formal separation from Casiciaco Recoletos Seminary. His readmission shall then be subject to the existing admission policies of
the Seminary.
6. For students who already requested their school credentials to be transferred to another school, kindly make your next TOR
requests to that school. In case you would like to request another copy from this school, please submit to this Office a Letter of
No Objection from your present school.

LETTER OF AUTHORIZATION

Address: __________________________________________
__________________________________________
Date: __________________________________________

THE REGISTRAR’S OFFICE

Casiciaco Recoletos Seminary, Inc.
Naguilian Road, Baguio City 2600

This is to certify that I, ______________________________________________________________________, with

ID No. ______________________ of (type of ID, issuing agency) ___________________________________ have personally authorized

Mr. / Ms. _______________________________________________________________whose signature appears below to obtain my

____________________________________________________________________ from Casiciaco Recoletos Seminary, Inc.

__________________________________________ __________________________________________
(Signature of Authorized Representative) (Printed Name and Signature of Applicant)

IF YOU WISH YOUR CREDENTIAL TO BE MAILED /

SENT VIA EXPRESS COURIER

Address: ___________________________________________
___________________________________________
___________________________________________

Contact Number: __________________________________________