Republic of the Philippines
Department of Education
Region X
SCHOOLS DIVISION OF GINGOOG CITY
TALISAY NATIONAL HIGH SCHOOL
Talisay, Gingoog City
JUNIOR HIGH SCHOOL
STUDENT’S CLEARANCE FORM
Please Check:
Grade 7
Grade 8
Grade 9
Grade 10
Section: ___________
Name of Student: _______________________ _____________________ ___________________
Last Name
First Name
Middle Name
LRN: ____________________________________________
Reason for Clearance:
Class Adviser: _____________________________________
Contact Number: ___________________________________
Academic Year: ____________________________________
OFFICES/PERSONNO. IN-CHARGE
1
NAME OF
TEACHER/
Clearing Officer
SIGNATURE
o
o
o
o
a. Enrolling
b. Transferring
c. Graduating
d. Others
_________________________
___
Date
REMARKS
LABORATORY/SHOP
(Dressmaking, Cookery, SMAW)
2
Roberto A. Acodili
3
COMPUTER
LABORATORY
SCHOOL LIBRARY
4
SSG ADVISER
Marvin A. Amarante
5
SCHOOL REGISTRAR
Mema G. Galeno
6
GUIDANCE
DESIGNATE
CLASS ADVISER
Dallas D. Baghari
Marvin A. Amarante
10
PREFECT OF
DISCIPLINE
ACADEMIC
COORDINATOR (Junior)
PTA TREASURER
11
SCHOOL PRINCIPAL
Lilibeth C. Estrosos
7
8
9
Gina L. Malagueña
Mema G. Galeno
Judith Balacuit
_____________________________________
Students Signature Over Printed Name
(In accomplishing the clearance please be guided by the instructions at the back
Address: National Highway, Brgy 22, Gingoog City
Tel. No.: (+632) 328-0108/0118
Email: gingoog.city@deped.gov.ph
Republic of the Philippines
Department of Education
Region X
SCHOOLS DIVISION OF GINGOOG CITY
TALISAY NATIONAL HIGH SCHOOL
Talisay, Gingoog City
INSTRUCTIONS
1. Secure student’s Clearance Form to class advisers.
2. Laboratory/Workshop Room in-charge clean the student of accountabilities in terms of utilization of
equipment/tools. The laboratory shop pertained to here are the following: Dressmaking, Housekeeping, Beauty
Nail Care, Cookery, SMAW
3. Computer Laboratory and School Library clears the student of accountabilities in terms of
computers/books or any other ComLab and Library materials.
4. Class Adviser clears the student of any required documents and financial obligations.
5. Class adviser clears the student of accountabilities concerning classroom maintenance; the class adviser
coordinates with the different subject teachers if there are academic requirements and other concerns that
needs to be settled.
6. Office of the Student Supreme Government (SSG) clears the student on matters that concerns namely;
school projects, activities as well as the different student organizations.
7. PTA Treasurer clears the student of any financial obligations.
8. Office of the School Principal clears the student upon confirmation with the SHS Coordinator as to the
fulfillment of the academic requirements.
9. Prefect of Discipline and Guidance Designate clears the student on matters that concerns with the
following; students record on attendance, haircut, behavior offenses and other concerns.
10. The Clearance shall be presented during enrollment or when claiming for transfer credential, SF 9,
SF10(form 137), diploma and other certification.
Note: The student needs first to write in full the names of the respective teachers/in-charge before requesting for their signatures.
Address: National Highway, Brgy 22, Gingoog City
Tel. No.: (+632) 328-0108/0118
Email: gingoog.city@deped.gov.ph