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Date: ____________________________

_____________________________
_____________________________
_____________________________
_____________________________

Sir/Madam:

Please furnish us a copy of Form 137/Transcript of Records and a Certificate of Good Moral Character of the
following student/s:

LRN Complete Name of Learner Current Previous Previous Teacher


Year Grade School
admitted Level/Section Year
Attended

1st/2nd/3rd/4th Request

Requested by:
__________________________

GCO F16
Guidance Counselor

GCO F16

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