BULACAN STATE UNIVERSITY BULACAN STATE UNIVERSITY

SARMIENTO CAMPUS SARMIENTO CAMPUS

City of San Jose Del Monte, Bulacan
Tel. no. (044) 815-4089
STUDENT CLEARANCE
Name: ________________________________________________________________
Student Number: _______________________________________________________
Course/Year/Section: ___________________________________________________
Contact Number: ______________________________________________________
Email Address: ________________________________________________________
Semester:
City of San Jose Del Monte, Bulacan
Tel. no. (044) 815-4089
STUDENT CLEARANCE
Name: ________________________________________________________________
Student Number: _______________________________________________________
Course/Year/Section: ___________________________________________________
Contact Number: ______________________________________________________
Email Address: ________________________________________________________
Semester:

Academic Year: _____________________________ Academic Year: _____________________________

CLASS ADVISER CLASS ADVISER

DEPARTMENT HEAD DEPARTMENT HEAD
LIBRARIAN Myra T. Acain LIBRARIAN Myra T. Acain
GUIDANCE Greegy G. Bolina GUIDANCE Greegy G. Bolina
STUDENT AFFAIRS HEAD Emmanuel Morata STUDENT AFFAIRS HEAD Emmanuel Morata
FINANCE Freddi Mar Mañalao FINANCE Freddi Mar Mañalao
REGISTRAR Imelda Gatchalian REGISTRAR Imelda Gatchalian
MEDICAL (for 1 year only)
st
Eric Paul Yambao MEDICAL (for 1st year only) Eric Paul Yambao
CAMPUS SECRETARY Elenita T. Capariño CAMPUS SECRETARY Elenita T. Capariño
CAMPUS DEAN Lorelei D. Consuelo CAMPUS DEAN Lorelei D. Consuelo

I hereby complied all the requirements for this semester. I hereby complied all the requirements for this semester.

________________________________________ ________________________________________
Name & Signature Name & Signature
____________________ ____________________
Date Date