Request Form For Transcript Of Records, Diploma And Certifications
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1LOYOLA SCHOOLS FORM RO-UG/G (REV. 2011)
Ateneo de Manila University
Registrar’s Copy
Loyola Schools
__________________________
OFFICE OF THE REGISTRAR
Document Officer’s Signature
REQUEST FORM FOR TRANSCRIPT OF RECORDS, DIPLOMA AND CERTIFICATIONS
Student ID No.
Due:
Date Requested:
Date
____________________________________
____________________________________________________________________________________________________
____________________________________
Name in Birth Certificate
Last)
(First)
(Middle Name)
(Landline/Mobile No.)
(
Married Name (if applicable)
REQUESTED BY:
Degree and Concentration
_________________________________
Year Level/Year Graduated
___________________________________
_________________________________
Printed Name & Signature
Last School Year Attended
______________________________
Undergraduate/College ( ) Graduate School/Masters/PhD ( )
GRANTED TRANSFER CREDENTIALS: ( ) Yes ( ) No
After Ateneo, have you ever enrolled in any other School/Graduate School?
( ) YES
( ) NO
If yes, please indicate name of school
*If a representative is accomplishing this request form, please fill-out the following section:
Name/Signature of Representative _____________________________________________________
Mobile No: _____________________________
Requested Documents (Pls. Check box)
Amount
No. of
Purpose of Request
Fees/Charges
Copies
TOTAL
Diploma
...........................................
P
CHED Authentication/CAV (Budget No. 100-254-000)
150.00
_______
_______
Transcript of records (per set) ………..................
165.00
Transfer Credentials ...........................
85.00
________
________
Certification......................................
85.00
Enrollment / Attendance
Units Earned/Grades
________
________
Completion of all Academic Requirements (Grad School)
________
________
Graduation and Special Order Number
English as a medium of instruction
Course description (P85.00/page)
Others
( please specify ________________________________________________)
Certification of Photocopied Credential
85.00
Diploma
S.O. Number
Grade Report
85.00
________
________
English Translation of diploma ..........
85.00
Documentary Stamps for Diploma/Transcript..
15.00
Mailing Fee (DCB-LBC 105-078-002)
Canister
35.00
TOTAL
P
_________
RECEIVED BY:
Date:
Name in Print & Signature
This form must be returned to the Registrar’s Office, Ground Floor, Social Sciences Bldg.
ATENEO DE MANILA UNIVERSITY
Student’s Copy
Loyola Schools
OFFICE OF THE REGISTRAR
Tel. No. (632) 426-6001 loc. 5131/5132
Date Requested :
Date Due :
Student Name :
Degree & Concentration
Last School Year Attended:
Year Level/Year Graduated:
Transcript:
Accounting (Faber Hall/W5): ____________________
Certified Correct:
Diploma:
Fee/Amount Paid:
Certification:
O.R. No.:
Doc. Stamp:
Cashier (Xavier Hall/W8):
Transcript Clerk
CAV
(Budget No. 100-254-000)
Mailing Fee
(DCB-LBC 105-078-002)
Canister
____________________
TOTAL
P
NOTE:
Present this stub together with the Official Receipt when claiming the requested document/s.
Representatives must present an AUTHORIZATION LETTER, I.D. cards (of owner & rep.) in addition to the above requirements.
Document/s not claimed after 90 DAYS from due date will be DESTROYED and payments made FORFEITED.
Pay only at the CASHIER; Cashier office hours: Monday-Friday: 8AM-12NN; 1PM-4PM, Saturday: 8AM-12NN
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