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Application for Graduation Form

The document is an application for graduation from Batangas State University for a student named Mikkaela Jane D. Salayo, who is pursuing a Bachelor of Science in Nursing. It includes personal information, educational background, and a data privacy agreement. The application outlines the necessary steps and requirements for graduation approval.

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Mikkaela Jane
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10 views1 page

Application for Graduation Form

The document is an application for graduation from Batangas State University for a student named Mikkaela Jane D. Salayo, who is pursuing a Bachelor of Science in Nursing. It includes personal information, educational background, and a data privacy agreement. The application outlines the necessary steps and requirements for graduation approval.

Uploaded by

Mikkaela Jane
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

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:
(if applicable)
SALAYO MIKKAELA JANE DAYA
BIRTHDATE:
SR CODE: 21-58927 07/14/2003 PLACE OF BIRTH: SANTA ROSA, LAGUNA
(MM/DD/YYYY)
HOME ADDRESS: ZIP CODE: 4026
PHASE 1E SAN LORENZO SOUTH SUBDIVISION, CONTACT NUMBER: 0976-339-7837
BRGY. MALITLIT, SANTA ROSA, LAGUNA
EMAIL ADDRESS: 21-58927@[Link]
SECONDARY SCHOOL SANTA ROSA SCIENCE AND TECHNOLOGY YEAR 2019
GRADUATED: HIGH SCHOOL GRADUATED:
ELEMENTARY SCHOOL YEAR 2021
GRADUATED: EMMANUEL CHRISTIAN SCHOOL GRADUATED:
DATE OF GRADUATION: DECEMBER, 20 MAY, 2025 MIDTERM, 20
COLLEGE: COLLEGE OF HEALTH SCIENCES
PROGRAM: BACHELOR OF SCIENCE IN NURSING
MAJOR:
Requested by: Evaluated by:

MIKKAELA JANE D. SALAYO v

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

ASST. PROF. RYSHEER Q. LEGASPI, RND, MSc


Signature over Printed Name of College Dean/ Signature over Printed Name of Authorized Official
Head, Academic Affairs Designation:
Date Signed: 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.

MIKKAELA JANE D. SALAYO


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.

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