Revised 2018 | Registrar's copy

APPLICATION FOR GRADUATION

*For Second Sem AY 2019-2020 Application Code: 14wz5564

Student Number: 14-5564 Date: February 21, 2020

BALANTAC STANLEY JOHN CORCINO

Last Name First Name Middle Name
COE BS in Mechanical Engineering April 26, 1998
College Degree Date of Birth
MARCOS ,ILOCOS NORTE Male 09278710515
Place of Birth Gender Contact Number
LYDIA (POB.), MARCOS, ILOCOS NORTE, PHILIPPINES
Home Address
RECORD OF PRE-UNIVERSITY EDUCATION
Name of School Year Graduated
Elementary : IMELDA ELEMENTARY SCHOOL 2010
Secondary : MARCOS NATIONAL HIGH SCHOOL 2014

Were you a TRANFEREE/SHIFTEE/CROSS ENROLEE? NO

Qualified as HONOR STUDENT as of First Sem, Fourth/Fifth Year? NO

Noted:
_________________________________ _________________________________
Student's Signature Adviser
O.R. # __________________________________
Date __________________________________ _________________________________
Department Chair
-------------------------------------------------------------------------------------------------------------------------------------------------------------
Revised 2018 | Dean's copy

APPLICATION FOR GRADUATION

*For Second Sem AY 2019-2020 Application Code: 14wz5564

Student Number: 14-5564 Date: February 21, 2020

BALANTAC STANLEY JOHN CORCINO

Last Name First Name Middle Name
COE BS in Mechanical Engineering April 26, 1998
College Degree Date of Birth
MARCOS ,ILOCOS NORTE Male 09278710515
Place of Birth Gender Contact Number
LYDIA (POB.), MARCOS, ILOCOS NORTE, PHILIPPINES
Home Address
RECORD OF PRE-UNIVERSITY EDUCATION
Name of School Year Graduated
Elementary : IMELDA ELEMENTARY SCHOOL 2010
Secondary : MARCOS NATIONAL HIGH SCHOOL 2014

Were you a TRANFEREE/SHIFTEE/CROSS ENROLEE? NO

Qualified as HONOR STUDENT as of First Sem, Fourth/Fifth Year? NO

Noted:
_________________________________ _________________________________
Student's Signature Adviser
O.R. # __________________________________
Date __________________________________ _________________________________
Department Chair
Procedure:
1. Request your Adviser and Department Chair to sign this form.
2. Pay graduation fee at the Cashier's Office.
3. Submit this form to the Registrar's Office together with your NSO Birth Certificate original or xerox and 2"x2" ID picture with royal blue
background and name tag.