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Form 3, Request Form

This document is a request form from the MSU-Iligan Institute of Technology Office of the Registrar. It contains instructions for requesting various documents such as certificates of enrollment, transcripts, diplomas, and other academic records. The form includes sections to fill out contact information, academic details, fees assessed, and requirements for claiming the requested documents. It provides a standardized way for students and alumni to initiate and track document requests from the registrar's office.

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Yukioh Amina
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© © All Rights Reserved
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109 views1 page

Form 3, Request Form

This document is a request form from the MSU-Iligan Institute of Technology Office of the Registrar. It contains instructions for requesting various documents such as certificates of enrollment, transcripts, diplomas, and other academic records. The form includes sections to fill out contact information, academic details, fees assessed, and requirements for claiming the requested documents. It provides a standardized way for students and alumni to initiate and track document requests from the registrar's office.

Uploaded by

Yukioh Amina
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Form 3: Request Form

(Updated: April 2012)

MSU- ILIGAN INSTITUTE OF TECHNOLOGY

OFFICE OF THE REGISTRAR


A. Bonifacio Avenue, Tibanga Highway, Iligan City 9200 website: http://www.msuiit.edu.ph
Telephone Nos: (063) 221-4050 to 55 Local: 178 or 4165 Telefax: (063)223-3794 e-mail: [email protected]

Date of Request
: ______________
Request Received by: ______________

Date Due: ________________


Remarks: _________________
Date Claimed: ______________

REQUEST FOR: [one (1) request form per document]


Part 1 :

Authentication ( Cert., OTR, Diploma)

Cert. 12.3: Former Student

Cert. 12.8: Graduating with GPA

Evaluation
Diploma

Cert. 12.4: English as a Medium of Instruction

Cert. 12.9: Completed Acad. Requirements

Cert. 12.5: English Units Earned, Student

Cert. 12.10: Graduation w/o GPA

Cert. 12.1: Current Student w/o GPA


Cert. 12.2: Current Student w/ GPA

Cert. 12.6: English Units Earned, Alumnus


Cert. 12.7: Current Student with Subjects Taken

Cert. 12.11: Graduation with GPA


Cert. 12.12: Academic Honors

Report of Grades: ______ Semester, SY_________________


COR Reprinting : ______Semester, SY_________________
Permit to cross-enrol
Others: ___________________________________________
Part 2:

Cert. 12.13: Valedictorian/Salutatorian


Cert. 12.14: Grade Equivalency
Cert. 12.15: Lost Diploma

Transfer Credential (TC)


Official Transcript of Records (OTR)
Certification, Authentication & Verification (CAV)

Direction 1: For part 1 document request, please fill entries under P. 1.


Direction 2: For part 2 document request, please fill entries under P.1 & P.2.
P.1. -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------I.D. No.:__________ Name: _____________________________Contact No: ____________ e-mail address: ____________________
Home Address: __________________________________________________________________
Student
Alumnus
Honor/Academic Distinction: _____________________ Date of Graduation: __________________ Degree/Course: ______________
Major/Option: _________________________________ Last Semester & SY of Attendance in IIT: _____________________________
Purpose of Request:___________________________________________________________________________________________
P.2. ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------Sex: ____________________ Date of Birth: ___________________________
Assessment of Fees (to be filled out by Staff):
Place of Birth: ___________________________________________________
Certification --------------------------------- 50
Citizenship: ____________________ Civil Status: ______________________
COR Reprinting ---------------------------- 20
Spouse (If Married): ______________________________________________
Report of Grades -------------------------- 20
Name of Father: _________________________________________________
Authentication (10/page@ ___pp) --Name of Mother (Maiden Name): _____________________________________
Evaluation ----------------------------------- 50
School Last Attended: _____________________________________________
TOR (50/page @ ___pp) --------------Transfer Credential --------------------- 150
Requested by:
Rush Job ---------------------------------- 60
------------------

Total Assessment -------------------- Php ___


_____________________________________

Signature over Printed Name

Assessed by: ________________________


Other Requirements:

Checklist for the release of requested document/s:


A. If claimed by the alumnus/student himself/herself, a valid Identification (ID) card must be presented:
B. If claimed by an authorized representative, the following items must be presented:
authorization letter;
Xerox copy of at least 2 (two) valid Identification (ID) cards of the authorizing person (owner); and
Original & valid Identification (ID) card of the authorized representative.

Clearance
___ pc/s Documentary Stamp/s
___ pc/s Long Brown Envelope/s

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