Request For Certificate Of Good Moral Character Form

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Reference No.: BatStateU-FO-OGC-03
Effectivity Date: July 28, 2017
Revision No.: 01
REQUEST FOR CERTIFICATE OF GOOD MORAL CHARACTER
Note: Please complete the information below
Date:
Student’s Name:
Sex: Male [ ]
Female [ ]
SR Code:
Campus:
Program:
Year & Section:
Purpose (please check):
[ ] OJT
[ ] Scholarship/Financial Assistance
[ ] Employment
[ ] Board Exam
[ ] Others, please specify: _________________________________________________
For OJT purpose only: (No payment)
I certify that Mr./Ms. _________________ has attended the OJT Orientation.
_________________________
SignatureOver Printed Name
OJT Coordinator
I certify that Mr. /Ms. ___________________ has /has not incurred any
Indicate Offense
o minor offense ________________________
o major offense ________________________
________________________
Signature Over Printed Name
Discipline Coordinator
For procedures and requirements needed, please see back page.
Reference No.: BatStateU-FO-OGC-03
Effectivity Date: July 28, 2017
Revision No.: 01
REQUEST FOR CERTIFICATE OF GOOD MORAL CHARACTER
Note: Please complete the information below
Date:
Student’s Name:
Sex: Male [ ]
Female [ ]
SR Code:
Campus:
Program:
Year & Section:
Purpose (please check):
[ ] OJT
[ ] Scholarship/Financial Assistance
[ ] Employment
[ ] Board Exam
[ ] Others, please specify: _________________________________________________
For OJT purpose only: (No payment)
I certify that Mr./Ms. _________________ has attended the OJT Orientation.
_________________________
Signature Over Printed Name
OJT Coordinator
I certify that Mr. /Ms. ___________________ has /has not incurred any
Indicate Offense
o minor offense ________________________
o major offense ________________________
________________________
Signature Over Printed Name
Discipline Coordinator
For procedures and requirements needed, please see back page.
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