University of San Jose-Recoletos

College of ________________ Department of_______________________

______ Semester A.Y. _________________

RESEARCH CLEARANCE
Name of Researchers:
_____________________________________ _____________________________________
_____________________________________ _____________________________________
_____________________________________ _____________________________________
_____________________________________ _____________________________________
_____________________________________ _____________________________________

Research Title:
_____________________________________________________________________________
____________________________________________________________________________

Checklist Remarks/ Signature

1. Final Manuscript (softcopy)

2. Members of the Panel

Panel A (payment, certificates,etc.)

Panel B (payment, certificates,etc.)

Panel C (payment, certificates,etc.)

Research Adviser

3. Certification (plagiarism & grammarly)

4. Certification from Ethics Review Board

Noted by:

______________________________ _____________
Research Teacher Date

Form 9 – Research Clearance