LICEO DE CAGAYAN UNIVERSITY

Rodolfo N. Pelaez Blvd., Kauswagan,

Cagayan de Oro City

GRADUATION
APPLICATION FOR GRADUATION PICTURE
The University Registrar
Liceo de Cagayan University
Cagayan de Oro City

Madam:

Please consider me as applicant for graduation for the degree of ___________________________________________ major
in _________________________________. At the end of the ________________ semester, academic year ____________________.

NAME: _____________________________________________________ Sex: ________ Age: ________ Status: _______________

PERSONAL DATA:
* Place of Birth: __________________________________ * Home Address: _____________________________________
* Date of Birth: ___________________________________ * CDO Address: ______________________________________
* Father’s Name: _________________________________ * Contact #: _________________________________________
* Mother’s Maiden Name: __________________________ * Religion: __________________________________________
RECORDS OF ELEMENTARY AND SECONDARY COURSES:
Elementary Name of School School Address School Year
Gr. 1
Gr. 2
Gr. 3
Gr. 4
Gr. 5
Gr. 6
High School
1st year
2nd year
3rd year
4th year
College
1st year
2nd year
3rd year
4th year
5th year

THE SUBJECTS CURRENTLY ENROLLED:

Subject Instructor
1. _________________________________________
2. _________________________________________
3. _________________________________________
4. _________________________________________
5. _________________________________________
Subject Instructor
6. ______________________________________________
7. ______________________________________________
8. ______________________________________________
9. ______________________________________________
10. ______________________________________________

EVALUATED BY: APPROVED BY: Very respectfully yours,

________________________ _________________________ ___________________________________________
Department Chair Dean Signature over printed name
(Applicant)
Please submit this form to the Registrar on or before _______________________ together with the following requirements:
 Course Prospectus w/ evaluation of the Department Chairman
 Photocopy of the NSO Birth Certificate Received by:___________________________________
 Photocopy of marriage contract (for female applicants only) Printed Name & Signature / Date
 Long brown envelop Office of the University Registrar