Republic of the Philippines

Department of Education
Region VII Central Visayas
Division of Bayawan City
ABUNDIO AGARPAO SR. MEMORIAL HIGH SCHOOL

STUDENTS’ CLEARANCE FORM

SY 2022-2023
STUDENTS’ CLEARANCE FORM
Reason for Clearance: ___ a. Enrolling ___b. Graduating ___c. Transferring SY 2022-2023

Name of Student: ___________________________________________________ Reason for Clearance: ___ a. Enrolling ___b. Graduating ___c. Transferring
Last Name) (First Name) (Middle Name)
Grade and Section: _________________________________ Name of Student: ___________________________________________________
Contact Number: __________________________________ (Last Name) (First Name) (Middle Name)
Grade and Section: _________________________________
No Department Clearing Officer Signature Date Contact Number: __________________________________
.
1. School ICT No Department Clearing Officer Signature Date
2. School Treasurer .
3. SSG Adviser 1. School ICT
4. School Paper Adviser 2. School Treasurer
5. GPTA Treasurer 3. SSG Adviser
6. Specialized Teacher 4. School Paper Adviser
7. PE Teacher 5. GPTA Treasurer
8. Immersion Teacher 6. Specialized Teacher
9. Property Custodian 7. PE Teacher
10. Class Adviser 8. Immersion Teacher
11. School Head 9. Property Custodian
10. Class Adviser
11. School Head

_________________________________________
STUDENT SIGNATURE OVER PRINTED NAME _________________________________________
STUDENT SIGNATURE OVER PRINTED NAME
Note: The student needs to write in the full names of each clearing officer before
requesting their signatures. Note: The student needs to write in the full names of each clearing officer before
requesting their signatures.