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Delen Christine Joy Pontines 18-53346 11-01-1999 22 Brgy. Conde Itaas, Batangas City Filipino 09165982354

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Reference No.: BatStateU-FO-REG-12 Effectivity Date: July 1, 2021 Revision No.

: 02

APPLICATION FORM FOR SHIFTER/TRANSFEREE


Request to:  Shift: 
___ From another College of the same Constituent Campus ___ From the same College
Transfer: ___ From another Constituent Campus ___ From other university
PERSONAL INFORMATION
Name of DELEN PONTINES
Student:
CHRISTINE JOY
Last Name First Name Middle Name Suffix
SR Code: 18-53346 Date of Birth: 11-01-1999 Age: 22
Permanent
Address:
BRGY. CONDE ITAAS, BATANGAS CITY
Nationality: FILIPINO Contact Number: 09165982354
Program Preferred Constituent
Applied for: BS MANAGEMENT ACCOUNTING Campus:
Previous Previous Constituent
Program: BS ACCOUNTANCY Campus/University:
Reason for Shifting/ FAILURE TO MEET THE REQUIRED GRADES FOR THE PROGRAM
Transferring:

Requested by:

CHRISTINE JOY P. DELEN


__________________________ ETHEL P. DELEN
__________________________
Signature over Printed Name of Student Signature over Printed Name of Parent/Guardian
Date Signed: 01-02-2022 Date Signed: 01-02-2022
---------- to be filled-out by the Evaluator of the Admitting College ----------
Course/s taken from Previous Program/University Final Credit Equivalent Course/s in the
Course Code Course Title Grade/s Unit/s Preferred Program

(Use extra sheets if necessary)


Evaluated and Interviewed by: Reviewed and Approved by:
Qualified to Shift/ Transfer:
Yes, Program: _______________________________
No, Reason/s: _______________________________

MA.____________________________
CONCEPCION MANALO ____________________________
Signature over Printed Name of Dean/Head, Academic Affairs
Department/Program Chairperson Date Signed:
Date Signed:

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---------- to be filled-out by Testing and Admission Office ----------
This part is applicable ONLY for applicants from other universities
Examination Rating Verified by: Remarks:

The student is eligible to shift program/


_______________________________ transfer:
Signature over Printed Name of
Authorized Official YES NO
Designation:
Date Signed:
To the Campus Registrar:

The applicant is allowed to shift/transfer to: under

the College of

effective Semester, Academic Year .

Sincerely yours,

_____________________________
Signature over Printed Name of
Dean/ Head, Academic Affairs
Date Signed:
Received by:

______________________________
Signature over Printed Name of Registrar’s Staff
Date Signed:

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Annex A
Republic of the Philippines
BATANGAS STATE UNIVERSITY
(Name of Campus)
(Campus Address)

PROPOSED COURSES FOR ENROLLMENT

Name: Program:
Campus: Academic Year:

YEAR 1
First Semester
Unit/s Pre-
Course
Course Title requisite/ Remarks
Code Lec Lab Co-requisite

Total Units
Second Semester
Unit/s Pre-
Course
Course Title requisite/ Remarks
Code Lec Lab Co-requisite

Total Units
Midterm
Unit/s Pre-
Course
Course Title requisite/ Remarks
Code Lec Lab Co-requisite

Total Units
(Use additional sheets if necessary)
Evaluated by: Approved by:

___________________________________ ___________________________________
Signature over Printed Name of Signature over Printed Name of
Department/Program Chairperson Dean/ Head, Academic Affairs
Date Signed: Date Signed:
Required Attachment: Program Curriculum

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