PUP-AFAS-5-UNRO-010

Rev. 1
June 19, 2019
REPUBLIC OF THE PHILIPPINES CONTROL NO.: ______________________
POLYTECHNIC UNIVERSITY OF THE PHILIPPINES APPLICATION FOR CHANGE OF ENROLLMENT
OFFICE OF THE UNIVERSITY REGISTRAR c ADDING OF SUBJECT
STA. MESA, MANILA c CHANGE OF SUBJECT
c
✔ WITHDRAWAL

COLLEGE/INSTITUTE :
STUDENT NUMBER : APPLICATION DATE: (mm/dd/yyyy)
NAME OF STUDENT :
COURSE/YR/SECTION : ACADEMIC YEAR: 20_____ - 20 _____ First Semester
Second Semester
REASON/S FOR CHANGE OF ENROLLMENT Summer

PLEASE CHECK THE APPROPRIATE BOX.

SUBJECT/S TO BE ADDED
TAGGED BY:
CODE SUBJECT TITLE DAY TIME ROOM UNITS FACULTY SIGNATURE
(Chairperson)

SUBJECT/S OR SCHEDULE TO BE CHANGED

FROM:
TAGGED BY:
CODE SUBJECT TITLE DAY TIME ROOM UNITS FACULTY SIGNATURE
(Chairperson)

TO:
TAGGED BY:
CODE SUBJECT TITLE DAY TIME ROOM UNITS FACULTY SIGNATURE
(Chairperson)

SUBJECT/S TO BE WITHDRAWN
TAGGED BY:
CODE SUBJECT TITLE DAY TIME ROOM UNITS FACULTY SIGNATURE
(Chairperson)

This form will only be processed if filled-up properly and completely during the adjustment period.

Number of units and hours (originally enrolled) I hereby apply for a change in my enrollment as stated
based on Registration Certificate : _________________ in this form, subject to existing rules and regulations
Number of units and hours added : _________________ of the University.
TOTAL number of units enrolled : _________________

APPROVED BY : ______________________________________________ _________________________________________________

DEAN/CHAIRPERSON SIGNATURE OVER PRINTED NAME OF STUDENT

DATE : ___________________________

ACKNOWLEDGED BY THE OFFICE OF THE UNIVERSITY REGISTRAR

Name: ___________________________ Official Receipt No.: (R.A. 10931)
Signature: ___________________________ Amount Paid : __________________
Date : ___________________________ Date : __________________