Human Resource Professor

CONTROL NO.:

REPUBLIC OF THE PHILIPPINES

POLYTECHNIC UNIVERSITY OF THE PHILIPPINES

OFFICE OF THE UNIVERSITY REGISTRAR

STUDENT RECORDS OFFICE

STA. MESA, MANILA

APPLICATION FOR

c LATE REPORTING OF GRADE

(Please attach certified photocopy of class record) c COMPLETION OF “INCOMPLETE GRADES”

(Please attach photocopy of Official Receipt)

c CORRECTION OF ENTRY

(Please attach certified photocopy of class record) c OTHERS, SPECIFY:

Date:

The Dean

College of:

I hereby request that

Student Number:

Name:

(Example: 2010-00001-MN-0)

(LAST NAME) (FIRST NAME) (MIDDLE NAME)

Course:

Year & Section:

Subject Code:

Subject Title:

School Year:

Term: c First Semester

c Second Semester

c Summer

School Session:

c Day

c Night Campus:

which was reported as:

due to the following reason/s:

be credited as one:

c who has “No Grade” in the Grade Sheets to a final grade of units. c who has completed all requirements with a final grade of units. c whose name in the Grade Sheet be corrected

From:

(LAST NAME) (FIRST NAME) (MIDDLE NAME)

To:

(LAST NAME) (FIRST NAME) (MIDDLE NAME)

c others, specify:

Thank you.

PROFESSOR/INSTRUCTOR

(SIGNATURE OVER PRINTED NAME)

APPROVED BY DEAN / CHAIRPERSON

Name:

Signature:

Date:

Received by Office of the Student Records, University Registrar. Name:

Signature:

Date:

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