Southern Luzon State University WAIVER FORM FOR ADMISSION

Student Admission Office

Lucban, Quezon WRITE LEGIBLY IN PRINTED FORM.
Program Chairperson’s Copy

Examinee number: _____________ Name of Applicant: _____________________________________________________ To

the Student Admission Office:

I would like to express my desire to be admitted in ___________________________________ (Program/ Course) of

______________________ (Campus). In consideration of my admission, I waive my rights to shift in any program/course being
offered in the university.

__________________________ __________________________
Signature of Applicant Date

__________________________ __________________________
Signature Over Printed Name Date
Parent/ Guardian

Southern Luzon State University WAIVER FORM FOR ADMISSION

Student Admission Office
WRITE LEGIBLY IN PRINTED FORM.
Registrar’s Copy
Lucban, Quezon

Examinee number: _____________ Name of Applicant: _____________________________________________________ To

the Student Admission Office:

I would like to express my desire to be admitted in ___________________________________ (Program/ Course) of

______________________________ (Campus). In consideration of my admission, I waive my rights to shift in any program/course
being offered in the university.

__________________________ __________________________
Signature of Applicant Date

__________________________ __________________________
Signature Over Printed Name Date
Parent/ Guardian

Southern Luzon State University WAIVER FORM FOR ADMISSION

Student Admission Office
WRITE LEGIBLY IN PRINTED FORM.

Lucban, Quezon __
Student’s Copy

Examinee number: _____________ Name of Applicant: _____________________________________________________ To

the Student Admission Office:

I would like to express my desire to be admitted in ___________________________________ (Program/ Course) of

______________________________ (Campus). In consideration of my admission, I waive my rights to shift in any program/course
being offered in the university.
__________________________ __________________________
Signature of Applicant Date

__________________________ __________________________
Signature Over Printed Name Date
Parent/ Guardian