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    Form 3, Request-Form

    Uploaded by

    Patrick Go
    This document is a request form for various documents from the registrar's office of the MSU-Iligan Institute of Technology. It contains sections for the requester to fill out their personal details and information about their degree. It also lists the various documents that can be requested, including certificates, transcripts, diplomas and other records. There are instructions that the requester or authorized person must present identification and other requirements depending on if they are requesting for themselves or on behalf of someone else. Fees for the different request types are also noted on the form.

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    © All Rights Reserved
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    Form 3, Request-Form

    Uploaded by

    Patrick Go
    156 views2 pages
    This document is a request form for various documents from the registrar's office of the MSU-Iligan Institute of Technology. It contains sections for the requester to fill out their personal details and information about their degree. It also lists the various documents that can be requested, including certificates, transcripts, diplomas and other records. There are instructions that the requester or authorized person must present identification and other requirements depending on if they are requesting for themselves or on behalf of someone else. Fees for the different request types are also noted on the form.

    Original Description:

    MSU-IIT Form 3, Request-Form

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    This document is a request form for various documents from the registrar's office of the MSU-Iligan Institute of Technology. It contains sections for the requester to fill out their personal details and information about their degree. It also lists the various documents that can be requested, including certificates, transcripts, diplomas and other records. There are instructions that the requester or authorized person must present identification and other requirements depending on if they are requesting for themselves or on behalf of someone else. Fees for the different request types are also noted on the form.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    156 views2 pages

    Form 3, Request-Form

    Uploaded by

    Patrick Go
    This document is a request form for various documents from the registrar's office of the MSU-Iligan Institute of Technology. It contains sections for the requester to fill out their personal details and information about their degree. It also lists the various documents that can be requested, including certificates, transcripts, diplomas and other records. There are instructions that the requester or authorized person must present identification and other requirements depending on if they are requesting for themselves or on behalf of someone else. Fees for the different request types are also noted on the form.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    of 2

    Form 3: Request Form

    (Updated: July 2013)

    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 Tele/fax: (063)223-3794
    e-mail: registrar@g.msuiit.edu.ph

    Date of Request

    : ______________

    Date Due: ________________


    Remarks: _________________

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


    Part 1:
    Authentication (Cert., OTR, Diploma)
    Evaluation
    Diploma
    Diploma Reprinting
    Cert. 12.1a: Current Student (summer)
    Cert. 12.1b: Current Student, units earned
    Cert. 12.1c: Current Student, GSIS
    Cert. 12.1d: Current Student w/o GPA
    Cert. 12.2: Current Student w/ GPA
    Cert. 12.3a: Former Student w/ GPA
    Cert. 12.3b: Former Student w/o GPA
    Cert. 12.4a: English as a Medium of Instruction, Student
    Cert. 12.4b: English as a Medium of Instruction, Alumnus

    Cert. 12.5a: English Units Earned, Student


    Cert. 12.5b: Education Units Earned, Student
    Cert. 12.6a: English Units Earned, Alumnus
    Cert. 12.6b: Education Units Earned, Alumnus
    Cert. 12.6c: Social Sciences Units Earned, Alumnus
    Cert. 12.6d: Language Units Earned, Alumnus
    Cert. 12.6e: Liberal Arts Units Earned, Alumnus
    Cert. 12.6f: Language/Liberal Arts. Social Sciences
    Units Earned, Alumnus

    Cert. 12.6g: English Units Earned with General


    Average, Alumnus
    Cert. 12.7: Current Student with Subjects Taken
    Cert. 12.8: Graduating with GPA

    Report of Grades: ____________________ Semester, SY________________________


    COR Reprinting: _____________________ Semester, SY________________________

    Part 2: Transfer Credential (TC)


    Official Transcript of Records (TOR)

    Cert. 12.9a: CAR Pending BOR Res.


    Cert. 12.9b: CAR w/o Thesis/Dissertation
    Cert. 12.10: Graduation w/o GPA
    Cert. 12.11: Graduation with GPA
    Cert. 12.12: Academic Honors
    Cert. 12.13: Valedictorian/Salutatorian
    Cert. 12.14: Grade Equivalency
    Cert. 12.15: Lost Diploma
    Cert. 12.16: No Objection
    Cert. 12.17: Course Description
    Cert. 12.18: Acceptance Notice
    Permit to cross-enroll

    Others: _____________________________

    2nd School Request


    Certification, Authentication & Verification (CAV)

    P.1. (For Part 1 document request, please fill entries under P. 1.)
    I.D. No.:_______________ Name: _____________________________________Contact No: __________________e-mail : _______________
    Home Address: ___________________________________________________________________________ Student
    Alumnus
    Mailing Address: ___________________________________________________________________________________________________
    Degree/Course: _________________________Major/Option: ______________________Honor/Academic Distinction: __________________
    Date of Graduation: ______________________________ Last Semester & SY of Attendance in IIT: _________________________________
    High School Graduated: _____________________________________________________________________________________________
    If transferee, last school/university attended: _____________________________________________________________________________
    Purpose of Request: ________________________________________________________________________________________________
    P.2. (For Part 2 document request, please fill entries under P.1 & P.2)
    Sex: ____________________ Date of Birth: ___________________________
    Place of Birth: ___________________________________________________

    Assessment of Fees (to be filled out by Staff):


    Certification --------------------------------------

    50
    Citizenship: ____________________ Civil Status: ______________________

    COR Reprinting ---------------------------------

    20
    Spouse (If Married): ______________________________________________

    Report of Grades -------------------------------

    Name of Father: _________________________________________________

    20
    Authentication (10/page@ ___pp) ---------

    Name of Mother (Maiden Name): _____________________________________


    50
    Name of Authorized Person: ________________________________________

    Evaluation

    ----------------------------------------

    Diploma Reprinting ---------------------------TOR (50/page @ ___pp) --------------------Transfer Credential -----------------------------

    150
    Requested by:

    Mailing & Handling (OIS 01)------------------

    250
    Rush Job ----------------------------------------60
    ----------_____________________________________

    Signature over Printed Name

    Total Assessment ------------------------ Php ____


    Assessed by: _____________________________
    Other Requirements:

    Clearance

    ___ pc/s Documentary Stamp/s

    ___ pc/s Long Brown Envelope/s

    Reminder:

    A. If requested by the person himself/herself named in the document, a valid Identification (ID) card must be presented.
    B. If requested by an authorized person, the following items must be presented:
    Authorization letter (Duly notarized authorization letter for CHED CAV request);
    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 person.

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