F-REG-023 REG'S COPY F-REG-023 COPY FOR THE F-REG-023 STUDENT'S COPY F-REG-023 COPY OF THE

Rev. 5 (04/17/18) Rev. 5 (04/17/18) ACCEPTING COLLEGE Rev. 5 (04/17/18) Rev. 5 (04/17/18) FORMER COLLEGE

LYCEUM OF THE PHILIPPINES UNIVERSITY LYCEUM OF THE PHILIPPINES UNIVERSITY LYCEUM OF THE PHILIPPINES UNIVERSITY LYCEUM OF THE PHILIPPINES UNIVERSITY
Manila Cavite Manila Cavite Manila Cavite Manila Cavite

Permit to Shift Program Permit to Shift Program Permit to Shift Program Permit to Shift Program

Name:__________________________________________ Name:__________________________________________ Name:__________________________________________ Name:__________________________________________

Student No.:_____________________________________
Shifting From: ___________________________________
(Former Course)
To: __________________________________
(Intended Course)
Student No.:_____________________________________
Shifting From: ___________________________________
(Former Course)
To: __________________________________
(Intended Course)
Student No.:_____________________________________
Shifting From: ___________________________________
(Former Course)
To: __________________________________
(Intended Course)
Student No.:_____________________________________
Shifting From: ___________________________________
(Former Course)
To: __________________________________
(Intended Course)

Reason/s for Shifting: _____________________________
_______________________________________________
By affixing my signature on this form, I hereby acknowledge and certify
that I have carefully read and understood the terms and conditions of the
Data Privacy Policy of the Lyceum of the Philippines University (LPU). By
providing personal information to LPU, I am confirming that the data is
true and correct. I understand that LPU reserves the right to revise any
decision made on the basis of information I provided should the
information be found to be untrue or incorrect. I likewise agree that any
issue that may arise in connection with the processing of my personal
information will be settled amicably with LPU before resorting to
appropriate arbitration or court proceedings within the Philippine
jurisdiction. Finally, I am providing my voluntary consent and
authorization to LPU and its duly authorized representatives to lawfully
process my / my child’s data information.
______________________________
Student’s Signature Over Printed Name
Reason/s for Shifting: _____________________________
_______________________________________________
By affixing my signature on this form, I hereby acknowledge and certify
that I have carefully read and understood the terms and conditions of the
Data Privacy Policy of the Lyceum of the Philippines University (LPU). By
providing personal information to LPU, I am confirming that the data is
true and correct. I understand that LPU reserves the right to revise any
decision made on the basis of information I provided should the
information be found to be untrue or incorrect. I likewise agree that any
issue that may arise in connection with the processing of my personal
information will be settled amicably with LPU before resorting to
appropriate arbitration or court proceedings within the Philippine
jurisdiction. Finally, I am providing my voluntary consent and
authorization to LPU and its duly authorized representatives to lawfully
process my / my child’s data information.
______________________________
Student’s Signature Over Printed Name
Reason/s for Shifting: _____________________________
_______________________________________________
By affixing my signature on this form, I hereby acknowledge and certify
that I have carefully read and understood the terms and conditions of the
Data Privacy Policy of the Lyceum of the Philippines University (LPU). By
providing personal information to LPU, I am confirming that the data is
true and correct. I understand that LPU reserves the right to revise any
decision made on the basis of information I provided should the
information be found to be untrue or incorrect. I likewise agree that any
issue that may arise in connection with the processing of my personal
information will be settled amicably with LPU before resorting to
appropriate arbitration or court proceedings within the Philippine
jurisdiction. Finally, I am providing my voluntary consent and
authorization to LPU and its duly authorized representatives to lawfully
process my / my child’s data information.
______________________________
Student’s Signature Over Printed Name
Reason/s for Shifting: _____________________________
_______________________________________________
By affixing my signature on this form, I hereby acknowledge and certify
that I have carefully read and understood the terms and conditions of the
Data Privacy Policy of the Lyceum of the Philippines University (LPU). By
providing personal information to LPU, I am confirming that the data is
true and correct. I understand that LPU reserves the right to revise any
decision made on the basis of information I provided should the
information be found to be untrue or incorrect. I likewise agree that any
issue that may arise in connection with the processing of my personal
information will be settled amicably with LPU before resorting to
appropriate arbitration or court proceedings within the Philippine
jurisdiction. Finally, I am providing my voluntary consent and
authorization to LPU and its duly authorized representatives to lawfully
process my / my child’s data information.
______________________________
Student’s Signature Over Printed Name

Action of the Guidance Office Action of the Guidance Office Action of the Guidance Office Action of the Guidance Office
( ) Qualified for the new course/program ( ) Qualified for the new course/program ( ) Qualified for the new course/program ( ) Qualified for the new course/program

___________________ ______________ ___________________ ______________ ___________________ ______________ ___________________ ______________

Guidance Director Date Guidance Director Date Guidance Director Date Guidance Director Date

Action of the College Action of the College Action of the College Action of the College
( ) Admitted ( ) Admitted ( ) Admitted ( ) Admitted
( ) Not Admitted. Remarks: _____________________________ ( ) Not Admitted. Remarks: _____________________________ ( ) Not Admitted. Remarks: _____________________________ ( ) Not Admitted. Remarks: _____________________________

___________________ ______________ ___________________ ______________ ___________________ ______________ ___________________ ______________

Dean Date Dean Date Dean Date Dean Date

Action of the Accepting College Action of the Accepting College Action of the Accepting College Action of the Accepting College
( ) Admitted ( ) Admitted ( ) Admitted ( ) Admitted
( ) Not Admitted. Remarks: _____________________________ ( ) Not Admitted. Remarks: _____________________________ ( ) Not Admitted. Remarks: _____________________________ ( ) Not Admitted. Remarks: _____________________________

___________________ ______________ ___________________ ______________ ___________________ ______________ ___________________ ______________

Dean Date Dean Date Dean Date Dean Date

Action of the University Registrar Action of the University Registrar Action of the University Registrar Action of the University Registrar
( ) Permit Granted Effective ( ) Permit Granted Effective ( ) Permit Granted Effective ( ) Permit Granted Effective
( ) 1st Sem. ( ) 2nd Sem. ( ) Summer Term ( ) 1st Sem. ( ) 2nd Sem. ( ) Summer Term ( ) 1st Sem. ( ) 2nd Sem. ( ) Summer Term ( ) 1st Sem. ( ) 2nd Sem. ( ) Summer Term
AY 20_____ - 20_____ AY 20_____ - 20_____ AY 20_____ - 20_____ AY 20_____ - 20_____

_____________________________ _____________________________ _____________________________ _____________________________

University Registrar / Date University Registrar / Date University Registrar / Date University Registrar / Date

Shifting effected in the school system Shifting effected in the school system Shifting effected in the school system Shifting effected in the school system

By: ___________________________ By: ___________________________ By: ___________________________ By: ___________________________