(Sample Clearance Form- all majors assigned in the same school should have uniform design using the

format put the logo of DepEd and the School)

May 3, 2023
Date

Dear Florly M. Callojellas:

Supervisor, Student Teachers

This is to inform you that Rhea R. Cordova is cleared from all

(Name of Student Teacher)

the requirements in Vito National High School, She has

(Name of Cooperating School)

completed 380 Hours prescribed by your institution.

No. of Hours

Very respectfully your,

__________________________________
Cooperating Teacher

Attested by:

___________________________________
Principal