Eastern Star Academy
Gen. Luna St., Sta. Ana, San Mateo, Rizal
Tel. nos. 475- 0972 and 654-06-62
STUDENTS’ CLEARANCE
Name:
______________________________
Grade Level: _________________________
LRN: ___________________________(if applicable)
Date: ________________________________
You must be cleared by each subject and submit the completed form to your Class Adviser. You can clear all the subjects in any order, but the Class
Adviser must be the last.
Reason for Student Clearance: (put a check)
 Graduation
 Moving Up
Department: (put a check)
 Grade School
 Junior High School
SUBJECTS
 Promotion
 School Transfer
 Senior High School
 College
SUBJECT TEACHER
SIGNATURE
DATE SIGNED
SIGNATURE
DATE SIGNED
NON-ACADEMIC MATTER
OFFICE
FOCAL PERSON’S NAME
GRADUATION FEE (if applicable)
CASHIER
JOAN DE LEON
REGISTRAR
JOAN DE LEON
SCHOOL FORM 9
SCHOOL FORM 10
PSA BIRTH CERTIFICATE
BINGO CARDS
MARISSA ILAGAN
TICKET
MARISSA ILAGAN
T-SHIRT
MARISSA ILAGAN
CLASS PICTURE
LOCKER
IZAA MANALO
ADVISER
TO THE OFFICE OF THE PRINCIPAL
RECEIVED AND VERIFIED BY:
DATE RECEIVED
Signature of the Department Head
CLEARED BY:
PIA MARIE C. ROXAS, MAED, MGC, LPT, RGC
Signature of the Principal
DATE RECEIVED