 www.pic.edu.ph Email: pic1@pic.edu.ph
TelNo: (632) 872-0773 TelFax: (632) 478-7710
Mobile No: (632) 926 668 3384
B-30 L-20 Silver cor. Marble Road,Pilar
Village, Las Piñas City Metro Manila
P H I L I P P I N E S 1750
DOCUMENTS REQUEST FORM
Student's Information
for PIC USE ONLY
Student Number:
Admission Department
Surname:
Previous Transcript
[
]
First Name:
Application Form
2x2 Picture
[
]
Middle Name:
Date of Birth:
[
Remarks
]
Signature over printed name
Contact Number:
Present / Home Address:
Registrar Division (Grades):
Email Address:
1st Term
Date Filed:
2nd Term
Student Signature:
3rd Term
Program/ Course in PIC:
Major:
Section / Venue:
Professor/Adviser:
4th Term
( for Master's Degree) 5th Term
(for Doctorate Degree) 6th Term
(for Bacherlor's Degree) 7th Term
Previous School Name:
(for Bacherlor's Degree) 8th Term
Remarks
Previous School Address / Branch:
Degree/Program/Course & Major:
Date of Graduation / Last year attended:
Transcript of Records' Remarks (put checkmark)
1. for Promotion Purposes only [ ]
4. for employment purposes only [ ]
2. for Evaluation Purposes only [ ]
3. for further studies, honorable dismissal is
needed
[ ]
5. for abroad purposes only [ ]
Signature over printed name
Registrar Division (Comprehensive
Examination)
Passed or Failed:
Signature over printed name
Registrar Division (Thesis / Dissertation
Writing)
6. others (please input):
*specify the college/university :
Remarks
Pre-Oral Defense:
for Student use (put the qty or check the document request
List of Documents:
Remarks
Put checkmark &
Quantity
1. Transcript of Records
[ ]
2. Complete Academic Requirements
[ ]
3. School Curriculum / Prospectus
4. Certifications:
*Grades
*Units Earned
*Registration
[ ]
Final Oral Defense:
Fee (for Payment Division use)
Signature over printed name
Registrar Division ( Manuscript
Submission)
Remarks
Thesis / Dissertation Book:
Softcopy (USB):
[ ]
[ ]
[ ]
*Enrollment [ ]
*Medium of Instruction [ ]
*Graduation [ ]
[ ]
5. Diploma
[ ]
6. School ID
7. CHED CAV Certification
*CHED Certification [ ]
*CAV Certification [ ]
*PIC Certification [ ]
*Other expenses (transportation) [ ]
8. Certified True Copy (please specify) [ ]
Signature over printed name
PAYMENT DIVISION
for Bachelor, Master's & Doctorate
Degree
1st Term
Balance / Remarks
2nd Term
3rd Term
4th Term
( for Master's Degree) 5th Term
(for Doctorate Degree) 6th Term
(for Bacherlor's Degree) 7th Term
(for Bacherlor's Degree) 8th Term
Signature over printed name
DOCUMENT/S PAYMENT
Official Receipt Number:
Date Paid:
Mode of Payment:
Total Amount Paid
9. Honorable Dismissal /Other request:
[ ]
Signature over printed name
Checked by:
TOTAL AMOUNT
Pacific InterContinental College
Signature over printed name
Director
Request Form