REQUISITION AND ISSUE SLIP
Teacher's Name : __________________________________ Printer Model Assigned:_______________
Subjects Handled : _______________________________________________ Do you have printer at home?: ______________________
________________________________________________ Model: _____________________________________
Requisition Module Intended Issue
Date Unit Description Quantity Week No. Others Running Totals to issued Signature
Requested by: Approved by: Issued by: Received by:
Signature :
Printed Name :
Designation :
Date :
AO 6/15/02
157