Reference No.: BatStateU-FO-REG-10 Effectivity Date: April 27, 2021 Revision No.

: 01

APPLICATION FOR GRADUATION

STUDENT INFORMATION
SURNAME: FIRST NAME: MIDDLE NAME: EXTENSION NAME:
ROCHA NICOLE ERICA CULLAR (if applicable)

BIRTHDATE:
SR CODE: 18-58381 09-07-2000 PLACE OF BIRTH: BATANGAS CITY, BATANGAS
(MM/DD/YYYY)
HOME ADDRESS: ZIP CODE: 4200
PUROK 1 STA. RITA KARSADA BATANGAS CITY, CONTACT NUMBER: 09519205782
BATANGAS nicolerocha485@gmail.com/
EMAIL ADDRESS: nicoleerica.rocha@g.batstate-
u.edu.ph
SECONDARY SCHOOL MANUEL S. ENVERGA UNIVERSITY FOUNDATION YEAR
2018
GRADUATED: CATANAUAN INC. GRADUATED:
ELEMENTARY SCHOOL YEAR
BAGUPAYE ELEMENTARY SCHOOL 2012
GRADUATED: GRADUATED:
DATE OF GRADUATION: DECEMBER, 20____ MAY, 20 22 MIDTERM, 20____
COLLEGE: COLLEGE OF ARTS AND SCIENCES
PROGRAM: BACHELOR OF ARTS IN ENGLISH LANGUAGE STUDIES
MAJOR: NONE
Requested by: Evaluated by:

NICOLE ERICA C. ROCHA ____________________________________

Signature over Printed Name of Student Signature over Printed Name of Registrar’s Staff
Date Signed: March 28, 2022 Date Signed:
Reviewed by: Approved by:

____________________________________ ____________________________________
Signature over Printed Name of College Dean/ Signature over Printed Name of Authorized Official
Head, Academic Affairs Designation:
Date Signed: Date Signed:
DATA PRIVACY AGREEMENT:

In submitting this form, I agree that my details be utilized for evaluating my academic records and for other purposes
relevant to my graduation. I also agree that the information I have indicated in this form be made available to the university,
and to other external agencies, groups and individuals for scholastic, research and employment purposes.

NICOLE ERICA C. ROCHA

Signature over Printed Name of Student

REMINDER: It is understood that should this application be approved, the candidate MUST COMPLY WITH ALL THE
REQUIREMENTS FOR GRADUATION before the Academic Council Meeting such as:
1. Photocopy of the Approval Sheet of Thesis/Dissertation
2. Certificate of Submission of hardbound copy of thesis in the Library

PROCEDURE

1. Secure and fill-out completely the Application for Graduation Form.

2. Go to the Registrar’s Office for Evaluation.
3. Proceed to your Dean’s Office for the review of the application.
4. Submit the application form to the Registrar’s Office.
5. Wait for the confirmation of the Registrar’s Office regarding the status of application.
6. After theconfirmation, pay the required fees.
7. Submit to the Registrar’s Office the receipt of payment for recording.