GRADUATION CLEARANCE FOR CLASS 2023 (APRIL)

Name:_____________________________________________Year & Section___________

1. CLASS MAYOR AND TREASURER

□Class Collection
□ Pinning Venue Fee
□Others:_________________(specify)

_______________________________ _________________________________
Class Treasurer Class Mayor
(Signature Over Printed Name) (Signature Over Printed Name)

2. OR/DR FACILITATOR
□ Complete Operating Room Cases and Delivery Room Cases
□ PRC FORM Printed and Signed by Clinical Instructor and Staff Nurse

□ Extensions Served
□ Repeat Rotations Served
□ RLE Clearance Manual
□ RLE Manual with attached final exam permit
□ Original copy of PRC OR/DR Cases Place inside a brown envelope (with
□ Summary of Clinical Rotations plastic envelope) and label with
name, section and year of
graduation.

□ Others:________________________(specify)

CHRISTIE N. CELLACAY, MAN, RN

LEVEL IV RLE COORDINATOR

ANTHONY JOSEPH C. MERCADO, MAN, RN

LEVEL IV ACADEMIC COORDINATOR

CLEARED:

JILL MARIE C. HERMOGENES, Ed.D.

Assistant Dean

Noted:

MICHELLE B. YU, DM
Dean