OFFICE OF THE

CAMPUS REGISTRAR
Siaton Campus, Siaton, Negros Oriental
APPLICATION FOR GRADUATION
THE REGISTRAR
Negros Oriental State University
Siaton Campus, Siaton, Negros Oriental

Sir/Madame:

I have the honor to apply for graduation for the title/degree of ______________________________________
__________________________________, major in ________________________________ as of ________ semester
of school year __________________.

Very Truly Yours,

_______________________________
Student’s Signature Over Printed Name
Note: The information will be indicated in the Commencement Program. Please Fill up legibly (ALL CAPS)
Name: __________________________________________________________________________________________
(Family Name) (First Name) (Middle Name)

Address: ________________________________________________________________________________________
(House No.) (Street) (Town/City) (Province/Country)

Recommending Approval:

____________________________________ _________________________
Dean Date
Received by:

MARIA LILIBETH K. DE LA PEÑA

____________________________________ _________________________
Registrar Date

Requirements to be attached:
1. Evaluation of Grades from the Dean
2. Course Curriculum/Prospectus
3. Photocopy of Accreditation Form (For Transferees)
This is to certify that a copy of the Application for Graduation of the student is retained at the Dean’s Office.

___________________________ ____________________
Secretary of the Dean Date
(Name and Signature)

EVALUATION OF STUDENT RECORDS (FOR THE REGISTRAR’S OFFICE PESONNEL ONLY)

Lacking Credentials:

Delinquencies (Failure, INC, Withdrawn Subjects, NG, Dropped Subjects)

Lacking Subject/s Lacking Subject/s For Overload/Simultaneous Total Units

RECOMMENDATION:
[ ] Recommendation for Graduation
[ ] Pending further Evaluation
Evaluated by: __________________________
 Date: __________________________
Form 13-Revised 2014