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ADAA-GO Form 14 (Revised 09-2016)

Graduate Office, College of Science


University of the Philippines
Diliman, Quezon City

APPLICATION FOR GRADUATION


(attach photo copy of your current Form-5)

Instructions to Applicant : Submit the filled up form to the Graduate Office not later than the scheduled deadline for
the Semester / Summer in which you expect to graduate.

Name : ________________________________________________________________ Student No. : _________


{Last} {First} {Middle/Maiden}

Degree Program : _______________________________ M.S. Option (Thesis : _______)/ (Non-Thesis _______)

Initial Enrollment in the Program : Semester (1st _____ ) (2nd _____ ) (Summer _____) A.Y. _______ - ________

Local Address : ______________________________________________________________________________

Permanent Address : _________________________________________________________________________

Telephone No . / Fax No. / Cell Phone No. : ________________________________________________________

E-mail Address : _____________________________________________________________________________

I expect to fulfill all degree requirements by ______________________________________________________

Signature : ___________________________________

Date : ___________________________________

RECOMMENDED BY : ENDORSED BY :

__________________________________________ ___________________________________________
Program /Thesis / Dissertation Adviser Chair, Graduate Committee

Date : __________________________________ Date : _____________________________________

Authorization to Release Personal Information :

[___] I am authorizing the Graduate Office to release the above personal information for the following purposes :

(Please check all applicable items).

[___] 1. employment opportunities [___] 2. research studies [___] 3. statistical surveys

[___] I am not allowing the Graduate Office to release any of the above personal information .

________________________________
Signature
Part 2 --

Name : __________________________________________________________________________________________

Degree Program : _____________________________________ Student Number : ___________________________

City Address (if any) ________________________________________________________________________________

_________________________________________________________________________________________________

Degree (s) Obtained School (s) were obtained Year of Graduation

Thesis / Dissertation Adviser :

Name : Institute/Program :

Rank : Unit :

Co-Adviser (if Any)

Name : Institute/Program :

Rank : Unit :

=================================================================================================

Checklists of Applicants Accomplishments : (For Student Records Evaluator)

Ph.D. Applicant : M.S. Applicant : (Thesis Option)


Completed Course Requirements Completed Course Requirements
Seminar / s Seminar / s
Penalty Subject (s) ( for MRR Students only) Penalty Subject (s) ( for MRR Students only)
Program of Study Program of Study
Candidacy / Comprehensive Exam ( Passed / Waived) Thesis Proposal
Qualifying / Preliminary Exam Thesis Committee
Colloquium Thesis Defense (Passed / Provisional)
Dissertation Pr0posal Bound copies and CD pdf
Dissertation Committee Other (s)
Dissertation Defense (Passed / Provisional)
Dissertation Pre-print/s (Published or about to Publish)
Bound copies and CD pdf M.S. Applicant : (Non-Thesis Option) / PMTEM
Other (s) Completed Course Requirements
Seminar / s
Diploma / M.A. Applicant Program of Study
Completed Course Requirements Penalty Subject (s) ( for MRR Students only)
Seminar / s Comprehensive Exam (Oral & Written)
Program of Study Other (s)
Penalty Subject (s) ( for MRR Students only)
Other (s)

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