CENTER FOR STATISTICS AND COMPUTING SCIENCES (CS)2

I N I T I A L C L E A R A N C E

____________________
Date
A. DESCRIPTION
Name: _______________________________________________________________________________
Course: ______________________________________________________________________________
Campus: _____________________________
Semester: ____________________________
S.Y.: ________________
(Proposed/Approved) Title of Thesis/Dissertation: ______________________________________________
_______________________________________________________________________________________
Adviser: ____________________________________________________________
Consulted Statistician from the Center:______________________________________________________
B. INITIAL CONSULTATION(to be filled out by the Center)
Presented Documents:
□ Proposed/Approved title
□ Statement of the Problem/Objective of the study
□ Statistical hypothesis
□ Experimental set – up (design, replication, blocks, randomization)
□ Sampling
 Sample size
 Sampling technique
□ Statistical plan/solution to the problem
Statistical tool(s)
Level of alpha
Actions Taken by the Center:
□ Statistically testable
Hypothesis/hypotheses
Problems
□ Appropriate method for data collection
□ Valid data gathering instrument (items in the instrument can solve the problem)
□ Suitable experimental set – up (design, replication, blocks, randomization)
□ Appropriate sampling procedure/setup
□ Appropriate statistical tool
Remarks: _________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
C. ASSESMENT /PAYMENT
ASSESMENT FEE PAYMENT
I. Initial Consultation: ______________ Official Receipt
No._______________
II. Additional charge: ______________ Date: ______________________
TOTAL: ______________
D. CLEARANCE
To whom it may concern:
This is to certify that M___ _________________________________________ has satisfactorily accounted
for all the fees and has completed the requirements set by the Center for the PROPOSAL STAGE.

______________________________ ______________________________
Statistician Center Head/Director