RF-011

April 17, 2023

CLEARANCE FORM
(Grade 11 Students)

PERSONAL INFORMATION: (Please sign in Print) School Student ID: 2023-S479

LAST NAME FIRST NAME MIDDLE NAME

CORROS JEANNIEL JOY DEGOMA

Section & Track:

HUMSS B ST.SIMON
Date released: Date submitted:

05/20-2024

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Parent’s/Guardian’s Signature over printed name Student’s Signature

CLEARANCE
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Class President E-TECH PAGBASA

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PPG Statistics and Probability Physical Health and Education

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21ST Century Literature DIASS Theology 101

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RWS Finance Personal Development

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Canteen Personnel Gatekeeper Guidance Office

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Class Adviser Prefect of Discipline School Registrar

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Christian Formation Senior High School Coordinator Office of Students Affairs

Recommending Approval: Approved by:

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School Principal School Director

Original copy of form must be submitted to the office of the School Registrar.