UNIVERSITY OF CAGAYAN VALLEY
(formerly Cagayan Colleges Tuguegarao)
Tuguegarao City, Cagayan, Philippines
BALZAIN CAMPUS
(078)844-1147/ 4215/ 4079/ 8978 – (Trunk Line)
(078)844-8978 – (Fax)
COLLEGE AVENUE CAMPUS
(078)844-8979
(078)844-8981 (College of Health)
e-mail address: cct_tuguegarao@yahoo.com.ph
UCV- RO-F-07
APPLICATION FORM FOR STUDENT’S CREDENTIAL
Name: _______________________________________________________
_________________
Date
Student No.: _____________________________
Home Address: _________________________________________________________________________________________
(Please check the document you need)
( ) Diploma -
Course: _______________________________
Year Graduated: ____________________
( ) Transcript of Records -
Course: _______________________________
Year Graduated/Enrolled: _____________
( ) Certificate of Eligibility of Transfer ( ) Copy of grades: Course: ___________________
( ) First Issuance
Inclusive Years: _____________
( ) Succeeding Issuance (2nd, 3rd, 4th, etc.)
( ) Others: _______________
Purpose:
(
(
) To transfer to another school
) Future reference
(
(
) Employment
(
) Others: __________________
) For Board/Bar Exam
__________________________________
(Student’s signature over printed name or
his/her authorized representative)
____________________________________________________________________________________________________________
STUDENT CLEARANCE FORM
Please request the signature of the School Officials below:
In case the student is not cleared, please
OFFICE/DEPARTMENT
state the reason.
1
Dean
2
Director of Libraries
3
Director of Guidance Center
4
Systems Head/Accountant
Remarks:
Signature
Date
Note:

Graduate School & Law students, accomplish Items 1,2 & 4 only

If the document requested is a certification, accomplish items 1 & 4 only.

If the applicant is not the owner of the document requested for, submit an
Authorization letter or SPA from the owner & a photo copy of a valid ID of the representative.
========================================== CUT HERE=============================================
UCV-RO-F-07
UNIVERSITY OF CAGAYAN VALLEY
Tuguegarao City
CLAIM STUB FOR STUDENT’S CREDENTIAL
Name ____________________________________________________________ Student ID No. _______________________________________
Type of Document Applied for: _____________________________________ Amount Paid ____________
Date of Filing ______________________
Official Receipt No.______________
Due Date (to be accomplished by the Custodian) ______________________________________________
Officer Receiving Application: ____________________________________ Position: _______________ Signature: __________________________
Note: Present this stub to claim document applied for on the due date. If the person claiming document is not the owner, attach authorization or SPA.
Documents Received by: ______________________________________________ Date Received: __________________________________________
(Signature over printed name)
UNIVERSITY OF CAGAYAN VALLEY
(formerly Cagayan Colleges Tuguegarao)
Tuguegarao City, Cagayan, Philippines
BALZAIN CAMPUS
(078)844-1147/ 4215/ 4079/ 8978 – (Trunk Line)
(078)844-8978 – (Fax)
COLLEGE AVENUE CAMPUS
(078)844-8979
(078)844-8981 (College of Health)
e-mail address: cct_tuguegarao@yahoo.com.ph
Date Revised: July 15, 2010
Revision Status: 02