NOTICE TO PARENT

Student’s Name Department

Semester and
Student Number
School Year

Deficiencies Date of Submission Remarks of Teacher

This notice shall serve as the final recourse of the teacher, and shall subsequently serve as an
agreement that the teacher, and the institution exercised due care, and diligence required,
and did not fail to exhaust all the necessary remedies in reaching out to the signatories
herein (both parent and student), to inform them about, and require the submission of all the
essential requirements needed to incur a passing grade, and that so much consideration was
given since the inception of the student’s delinquency.

The signatories herein agree to the following terms:

 I am well aware about my deficiencies in my class:
 I am well aware, and fully understand
 I am well aware, and fully understand
 I am well aware, and fully understand to the best of my knowledge, and thus,
consequently agree
I have read in full and agree to the terms and conditions specified herein, evidenced by having affixed my signature below.

Signature of student over printed name Signature of parent over printed name