Reference No.: BatStateU-FO-REG-10 Effectivity Date: May 18, 2022 Revision No.

: 02

APPLICATION FOR GRADUATION

STUDENT INFORMATION
SURNAME: FIRST NAME: MIDDLE NAME: EXTENSION NAME:
JUSON VINCENT JAY JR. CARENAN (if applicable)

BIRTHDATE:
SR CODE: 20-52440 11/06/2001 PLACE OF BIRTH: BATANGAS CITY
(MM/DD/YYYY)
HOME ADDRESS: ZIP CODE: 4213
BARANGAY 8. CONTACT NUMBER: 0916-333-7949
BALAYAN, BATANGAS
EMAIL ADDRESS: 20-52440@g.batstate-u.edu.ph

SECONDARY SCHOOL BALAYAN NATIONAL HIGH SCHOOL (JHS) YEAR 2018 (JHS)
GRADUATED: IMMACULATE CONCEPTION COLLEGE INC. (SHS) GRADUATED: 2020 (SHS)
ELEMENTARY SCHOOL YEAR
BALAYAN EAST CENTRAL SCHOOL 2014
GRADUATED: GRADUATED:
DATE OF GRADUATION: DECEMBER, 20____ MAY, 20____ MIDTERM, 20____
COLLEGE: COLLEGE OF TEACHER EDUCATION
PROGRAM: BACHELOR OF PHYSICAL EDUCATION
MAJOR: PHYSICAL EDUCATION
Requested by: Evaluated by:

VINCENT JAY JR. C. JUSON Ms. KRYSTEL D. MAGNAYE

Signature over Printed Name of Student Signature over Printed Name of Registrar’s Staff
Date Signed: February 8. 2024 Date Signed:
Reviewed by: Approved by:

Dr. REALIZA M. MAME Ms. MARY GRACE A. ESCAREZ

Dean, CTE Head, Registration
Date Signed: Designation:
Date Signed:
DATA PRIVACY AGREEMENT:

☑ In submitting this form, I agree that my details be utilized for evaluating my academic records and for other purposes
relevant to my graduation. I also agree that the information I have indicated in this form be made available to the university,
and to other external agencies, groups and individuals for scholastic, research and employment purposes.

VINCENT JAY JR. C. JUSON

Signature over Printed Name of Student

REMINDER: It is understood that should this application be approved, the candidate MUST COMPLY WITH ALL THE
REQUIREMENTS FOR GRADUATION before the Academic Council Meeting such as:
1. Photocopy of the Approval Sheet of Thesis/Dissertation
2. Certificate of Submission of hardbound copy of thesis in the Library

PROCEDURE

1. Secure and fill-out completely the Application for Graduation Form.

2. Go to the Registrar’s Office for Evaluation.
3. Proceed to your Dean’s Office for the review of the application.
4. Submit the application form to the Registrar’s Office.
5. Wait for the confirmation of the Registrar’s Office regarding the status of application.
6. After the confirmation, pay the required fees.
7. Submit to the Registrar’s Office the receipt of payment for recording.