Republic of the Philippines

WESTERN MINDANAO STATE UNIVERSITY

College of Engineering- College Student Council
Normal Road, Baliwasan, Zamboanga City 7000

ACKNOWLEDGEMENT FORM AND WAIVER

OF FEES FOR 1 ST SEMESTER

Greetings in the name of Student Development!

The College of Engineering – College Student Council (COE-CSC) is the supreme

representation of the College of Engineering tasked to serve the entire students at the said
college. For the span of Two (2) consecutive academic years, the students are deprived of their
college life because of the pandemic brought by COVID-19.

This academic year, the officers of the different Student Chapter and the College
Student Council shared a common goal of giving the students a better and memorable school
year. With this, the COE-CSC as well the Student Chapter of the different Engineering
Departments conducts activities for the betterment of the College of Engineering students. As
for Engineering, most of the activities and exams as well as presentations for thesis defense
are usually face to face. Therefore, yearly collection is an integral part in doing such activities
and projects that will benefit the students.

However, the organization that was mentioned doesn’t have enough funds to sustain
the upcoming projects and activities for the betterment of the students to accomplish projects
and activities.

In line with this, the College of Engineering-College Student Council and as well as
the Student Chapter Presidents from the ten (10) Student Chapter Department is submitting the
total breakdown of the Collection of Fees for the First Semester of A.Y 2022-2023.

CSC Activity Fee ……………………………………… Php. 200.00

Insurance Fee …………………………………………...Php. 70.00
Student Chapter Fee……………………..…………….. Php. 300.00
Polo Shirt (OPTIONAL) ……………………………….Php. 500.00
 Republic of the Philippines
WESTERN MINDANAO STATE UNIVERSITY
College of Engineering- College Student Council
Normal Road, Baliwasan, Zamboanga City 7000

The COE-CSC and Student Chapter will surely collect (INSERT AMOUNT) ONLY
the total fees/collection presented above which is intended for the upcoming activities of the
council and student chapter for the first semester of A.Y 2022-2023.

May this find you in good spirits and merit your most favorable response. Attached
herewith is the waiver for the acknowledgement of reading and signing knowingly and
voluntarily.

Sincerely yours,

RISHELJANE J. DIONALDO JAZPHER MARC P. UMPAD

Mayor, College of Engineering-CSC Vice Mayor, College of Engineering-CSC

ARWINA H. SALCEDO
Senator, College of Engineering

ARZEL BABES S. MORALES JOHN HAKIM P. TANGKUSAN

Agricultural & Biosystems Engineering Councilor Civil Engineering Councilor

MARK ERVINS P. COLUMBRES JUSTIN JAMES B. JUATON

Civil Engineering Councilor Computer Engineering Councilor

KHLINE IVERSON G. DAWANG ERSHIRL JOLYNNE G. PAUSANOS

Electrical Engineering Councilor Electrical Engineering Councilor

VICTORIA CAMILLE M. BUCOY RALPH S. HIBIONADA

Environmental Engineering Councilor Electronics Engineering Councilor
 Republic of the Philippines
WESTERN MINDANAO STATE UNIVERSITY
College of Engineering- College Student Council
Normal Road, Baliwasan, Zamboanga City 7000

NOEL S. ALAIR ALFAIDZ L. ABDURAJI

Industrial Engineering Councilor Geodetic Engineering Councilor

ROSENA LUCY M. HAIRULLA JANINE CARLA L. ARIOLA

Mechanical Engineering Councilor Mechanical Engineering Councilor

JESHIER JOHN H. FELICIANO

Sanitary Engineering Councilor.

STUDENT CHAPTER PRESIDENTS

 Republic of the Philippines
WESTERN MINDANAO STATE UNIVERSITY
College of Engineering- College Student Council
Normal Road, Baliwasan, Zamboanga City 7000

I, __________________________________, from the department of

___________________________, and a resident of _______________________, do hereby
voluntarily participate in the Collection of Fees for the 1st Semester under the following
TERMS AND CONDITIONS:

I acknowledge that the College of Engineering - Western Mindanao State University

has provided me with all the necessary information relative to my participation in the
above stated activities.

I have read and fully understand the guidelines issued by the College Student Council
and the Student Chapter pertaining to the collection that was mentioned above.

I fully understand that the course of my participation in the above stated activities, may
be subject to the betterment of the college as well as the College of Engineering
Students.

I understand that it is my responsibility to take every precaution and to strictly comply

with all relevant rules and regulations, policies, and laws.

I acknowledge that my failure to comply with the said obligations may lead to the
termination of my participation with the aforementioned activities.

I fully agree to knowingly and willingly assume all the risks and responsibilities
associated with my participation in the above stated activities of Western Mindanao
State University.

To the maximum extent permitted by law, I release, hold harmless the WMSU College
of Engineering and its officers, directors, faculty, staff, representatives, employees and
agents, as well as officers of the Affiliating Institution/s, from and against any present
or future claims, loss or liability for property which I may suffer, related to my
participation in the above-stated activities.

I acknowledge that I have read and understood the document, I accept its terms,
and I sign it knowingly and voluntarily.

____________________________________ ____________________________
Signature over printed Name of Student Signature over printed Name of
Parent
Date: Date: