BATAAN PENINSULA STATE UNIVERSITY BPSU-ROF-018GS

OFFICE OF THE UNIVERSITY REGISTRAR revised 03/01/2019

Photo
City of Balanga 2100 Bataan 2" x 2" APPLICATION
PHILIPPINES in formal attire FOR
with white background GRADUATION
and name
CAMPUS MAIN
(LN, FN MN)
Date
The University Registrar (mm/dd/yyyy)
This University

Sir:
I expect to finish my program this ____________
First Trimester of Academic Year 20___ - 20___ with the degree of
Doctor of Education
____________________________________________________________, major in ____________________________.

Personal Data Schools Attended

Name (LN, FN MN) Elementary

Student No. Sex: Male  Female Year Graduated

Date of Birth Civil Status Single Secondary
Place of Birth
Permanent Address Year Graduated
College
Father's Name
Mother's Birth Name Year Graduated
Email Address Post Bacc.
Contact Number
Year Graduated
Date of Comprehensive Examination: Graduate
Date of Thesis/Dissertation Defense:
Title of Thesis/Dissertation: Year Graduated

First
I hereby certify that I am currently enrolled for the _____________ Trimester, AY 20___ - 20___ and that I have
complied with all the course requirements of the program.

(Signature over Printed Name of Student)

DATA PRIVACY CONSENT FORM

Upon submission of this application for graduation, I hereby affirm that I am allowing Bataan Peninsula State University to
 post my name and the degree I am about to earn on the BPSU OUR FB Page as candidate for graduation and
 on Campus Registrar's bulletin board with my deficiencies, if any.
In the event my graduation is approved by the University's Board of Regents upon the recommendation of the
Academic Council, I am allowing Bataan Peninsula State University to
 publish my name and the degree that I earned including any honors received in the program to be distributed,
 include my name and degree that I earned in slideshow presentations during the Commencement Exercises.
I understand that the University is seeking my consent as the posting and graduation program may be accessed by
members of the public.

(Signature over Printed Name of Student)

Date Signed:

DO NOT FILL OUT THIS PORTION

(For Program Clerk's Use Only) As per evaluation:
[ ] No deficiency
Received by: [ ] With deficiency in:
Date and Time:

Evaluated by:
Date and Time: Lack following entry credentials:
[ ] ToR from previous school
Application for graduation is [ ] PSA-issued Birth Certificate
[ ] Confirmed [ ] Denied [ ] Others ____________________________