Republic of the Philippines Document Code: CAS-BF-002

UNIVERSITY OF ANTIQUE
Revision No.: 00
Sibalom, Antique
Telefax No. (036) 543-8161 Effectivity Date: January 2016
E-mail: ua@antiquespride.edu.ph Page: 1 of 2
PROGRAM SHIFTING FORM

Date
To: Dean _____________________________

College of ______________________________

I ,
Students’ Name Course, Year & Section
with the concurrence of my dean request to transfer to your college subject to the existing policies of
the

University, effective 1st/2nd Sem __Summer A.Y., 20__ - 20__.

Noted:

Student’s Name & Signature Parent’s Name & Signature

Concurred: Action Taken:

Approved
Disapproved

Printed Name & Signature of Dean (Origin) Printed Name & Signature of Dean

Dean’s Copy

Republic of the Philippines Document Code: CAS-BF-002

UNIVERSITY OF ANTIQUE
Revision No.: 00
Sibalom, Antique
Telefax No. (036) 543-8161 Effectivity Date: January 2016
E-mail: ua@antiquespride.edu.ph Page: 2 of 2
PROGRAM SHIFTING FORM

Date
To: Dean _____________________________

College of ______________________________

I ,
Students’ Name Course, Year & Section
with the concurrence of my dean request to transfer to your college subject to the existing policies of
the

University, effective 1st/2nd Sem __Summer A.Y., 20__ - 20__.

Noted:

Student’s Name & Signature Parent’s Name & Signature

Concurred: Action Taken:

Approved
Disapproved

Printed Name & Signature of Dean (Origin) Printed Name & Signature of Dean

Registrar’s Copy