________________________________

Name of School

CERTIFICATION

TO WHOM IT MAY CONCERN:

This is to certify that __________________________________ is officially enrolled

as Grade ___ student at ________________________________ School, DepED–La Carlota City
for School Year 201__ – 201__.

This is to certify further that he/she is a student of good moral character.

This certification is issued to the above–named student for the purpose of

________________________.

Signed this ___ day of _________ 201__ in La Carlota City, Negros Occidental,
Philippines.

_________________________________________
Name & Signature of Guidance Teacher / Counselor

_________________________________
Name & Signature of School Head

CC – School File