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CEBU DOCTORS' UNIVERSITY

College of _ _ _ _ _ _ _ __
APPLICATION FOR CLEARANCE
Check the appropriate box: D GRADUATING D NON-GRADUATING

Name of Student:~--~~~~~--~~~------------~---~---~----------
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(Last Name) (First Name) (Middle Name)
Home Address: -
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Last Curriculum enrolled in (Course & Year):_ _ _ _ _ _ _ _ _ _ _ _ _ _· ---------
School Year Attended - From : Summer _ _ _ _
. _1st Semester _ _ _ _2nd Semester Year: _ __

To : Summer _ _ _ _ _ 1st Semester _ _ _ _2nd Semester Year: _ __

I.D. Nl1mber: _ _ _ _ _ _ _ (Schaal l.D. to be surrendered at the Regjstrar's.Qffic()

Email Address: •

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Signature of Student •

FOR STUDENT WHO APPLIED FQR I

TRAN.SFER C~DENTll\L PLEA§E SUBMIT FOR SIGNATURES:

THE FOLLOWING: Biology Dept. •

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Chemistry
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Physics Dept.
Zoology Dept.
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Anatomy Dept. ·-----.....- - - -

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Dentistry
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Optometry "\
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• FOR ACS/BSCS ONLY
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This is to certify that the applicant Is cleared of flnanclal and property obligations
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ADMINISTRATION .

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LIBRARY · •
DEPARTMENT CHAIRMAN
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STUDENT AFFAIRS OFFICE CDU DORMITORY •

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CDU CASHIER • CDUH BUSINESS OFFICE
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(for hospital ac~ounts)
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CDU ACCOUNTING OFFICE •

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. CDU-COH COUNCIL -ON HEAL TH •

GUIDANCE COUNSELOR RESEARCH & DEVELOPMENT

(For Exit Interview) '

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REGISTRAR'S OFFICE RECORDS •

COLLEGE DEAN UNIVERSITY REGISTRAR

FOB <;JAA,DUA TINq §TUQENTS ONLY . -
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-YEARBOOK
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. ALUMNI AFFAIRS
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SUBMIT TO THE REGISTRAR'S

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OFFICE: . - . ----i~ 2 pieces 2x2 picture white background
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Revised:05/18/16 - ··~~ CDU official Receipt.·
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CEBU DOCTORS' UNIVERSI I Y •

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Mandaue City, Cebu · • •
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LABOBATQRY eREA~~~l DEPQSI' I-« WI I HDRWAL
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School Year Attended- From: Summer ___ 1st Semester _ _ __ 2~ Semester Year: _ __ •

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To . : Summer ___ 1st Semester - -..- . - 2nd Semester Year: _ _. ·-

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LAf30RATORY .DEPQS.((S;, •
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School Year ·_ ._·_· ____._ _ _ _.._to - - - - - - -·_ ·Php - - - - - - - - •
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LESS: Breakages and Losses •

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TOTAL LABORATORY REFUNDABLE TO .STUDENT .....................:.. ~........... Php ..._

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·CLEARANCE FB()r:t .LAl<lBArOR! 'I ttHtllCIANS . l

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ZOOLOGY DEPARTMENT • • •••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••• '
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. BIOLOGY DEPARTMENT, ·. • • ...•..•....•...........•

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CHEMlS I RY DEPARTMENT •
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PHYSICS DEPARTMENT • •
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PATHOLOGY · •
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HISTOLOGY DEPARTMENT ••
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MEDICAL TECH. DEPT. ········································••••4••············-······
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OPTOMETRY ·
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PHYSIOLOGY DEPARTMENT ...•..•.......•..•.... , . -......••..
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COMPUTER LABORATORY • • •
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For ACS/BScs .
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APPROVED: •
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.I• VEREFIEO & ASSESSED· BY:
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COLLEGE DEAN •
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ASSESSMENT CLERK •

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