Form 1

University of the Philippines Visayas

Iloilo City

APPLICATION FOR GRADUATION

__________________________
Date

The Dean
College of ___________________________
U.P. Visayas
Iloilo City

Sir/Madam:

I wish to apply for graduation with the degree of ________________________

____________________________ major in ____________________________________
as of the end of the _____________trimester/semester, AY ______________.

Please have my academic records examined and have my name included in the list
of candidates for graduation which will be presented to the faculty for approval.

Truly yours,

_______________________
Signature of Student

________________________
PRINTED NAME

________________________
Student Number

/joj/7/06/01
Form 2

_____________________________
Date

The University Registrar

University of the Philippines
Diliman, Quezon City

Sir/Madam:

In connection with my graduation, I am submitting the data below:

Very truly yours,

_______________________
Signature
_____________________________________________________________________
FOR THE DIPLOMA & COMMENCEMENT PROGRAM : (Print legibly)

Full Name_________________________________________________________
Address___________________________________________________________
Candidate for graduation with the degree of ____________________________
_____________________________________________________
Date of Graduation:________________________________________________
Previous degree(s)/title(s)___________________________________________
__________________________________________________________
Institution from where obtained_________________________________
Date obtained ______________________________________________
Title of Thesis (for candidate for master’s degree only):
__________________________________________________________
Paid Graduation Fee: P300.00 O.R.#_____________Date____________

DEADLINE TO SUBMIT THIS FORM TO THE OFFICE OF THE

REGISTRAR:_________________________
Date
FOR THE OFFICE OF ALUMNI RELATIONS: (Print legibly)

Full Name_________________________________________________________
Candidate for the title/degree of______________________________________
Date of Graduation_________________________________________________
Previous title/degree from U.P._______________________________________
Permanent Mailing
Address:________________________________________________________

/joj/7:09:01
Form 3
University of the Philippines
Iloilo City

APPLICATION FOR GRADUATION

(To be accomplished in duplicate)

Address:____________________________
____________________________
Date:_______________________________

The Dean
College of ________________
U.P. Visayas
Iloilo City

Sir/Madam:

I have the honor to apply for graduation for the degree of________________
________________________________________________________.
Further information regarding my degree program are as follows:

Type of Degree Program Field of Specialization

_________________________ ______________________________

I expect to comply with all academic and non-academic requirements for

graduation by the end of ________trimester/semester of Academic Year ________.

May I request that my academic records be evaluated and that I will be informed
of my deficiency in connection with graduation requirements as early as possible.
Thank you.

Very truly yours,

_______________________
Signature
________________________
PRINTED NAME
________________________
Student Number

NOTE:Please refer to back page for Record Evaluation by Academic Division concerned.
/joj/7/09/01
Form 4

University of the Philippines Visayas

Iloilo City

EVALUATION OF RECORDS FOR GRADUATION PURPOSES

Name of Applicant ______________________________________________________

(Please Print) (Family) (Given) (Middle Initial)

Degree Program__________________________________________________________

End of
First Trimester/Semester Academic Year ______________
Second Trimester/Semester
Third Trimester/Summer
________________________________________________________________________
(To be accomplished by Program Adviser)

Subjects still to be taken Subjects with unremoved grades of “4” or “Inc.”

Course No. Units Course No. Grade Trimester/ Academic
Semester Year
Incurred

Candidate for Graduation with Honors:______________________________________

General Weighted Average as of the end of ________Trimester/Semester, AY_______

_______________________________________________________________________
Evaluated by:

_____________________________
Program Adviser

_____________________________
Date
NOTED:
____________________
Division Chairman
____________________
Date
 INFORMATION USE CONSENT FORM

In the event my graduation is approved by the University of the Philippines Board

of Regents upon the recommendation of the proper University bodies, I am allowing the
University of the Philippines _____________ (Constituent University) to publish my name
and the latest degree or certificate that I earned including any honors received and any
previous degrees earned, in the program to be distributed during the commencement
exercises. I understand that the University is seeking my consent as the graduation program
may be accessed by the public.

I further confirm that the University, through the UP System Office of Alumni
Relation (OAR) and other appropriate offices such as the University Registrar are
authorized to provide my name, degrees/certificate(s) and honor(s) earned, contact
information as well as such other personal information that will enable my identity to be
verified, to the University of the Philippines Alumni Association and its official chapters
so as to enable the University to comply with RA 9500.

_______________________________
Signature and Printed Name

_______________________________
Date