Received by:

DATE

Asst. Prof. JV Ignacio

Asst. Prof. John Vincent Ignacio, MALT Date:_______
Department of Philosophy, Faculty of Arts & Letters
University of Santo Tomas

RE: Request for _________________________________

Dear Asst. Prof. Ignacio:

Good day!

I write to you to request for a _____________________________________________________.

I missed the regular activity because__________________________________________________
______________________________________________________________________________
_____________________________________________________________________________.

I am hoping for your kind consideration for my request. Thank you very much for your time and
may the Almighty continue to bless you and our university.

Respectfully,

________________________________
(Signature over Printed Name of Student)
Section: __________ Student Number: ___________
College of___________________________________

Noted and Endorsed by:

__________________________
(Signature over Printed Name of Parent/Guardian if student is below 18 yo)
Date:______

_____________________________
(Signature over Printed Name of Class Adviser / Department Head / SWDB / Dean)
Date:_______

NOTE: MAKE TWO COPIES. The original copy goes to the Course Instructor/Facilitator and the
second copy is for the student making the request. If necessary, attach copies of any pertinent
document such as authenticated Medical Certificates, letters of invitation, plane ticket, etc.