CHECK THE CATEGORY THAT APPLIES:

COMPLIANCE DOCUMENT DOCUMENT

NEW DOCUMENT
PULL-OUT (Central Office Only)
CODE:
(Regional Office - CO-
Control No.)

NAME OF SCHOLAR: UNID:

SHEI: DHEI:

PREVIOUS BATCH CHECK THE TERM THAT APPLIES:

(Central Office Only)
AY 2016-2017 AY 2017-2018 AY 2018-2019
TERM 2 TERM 1 TERM 1
TERM 3 TERM 2 TERM 2
TERM 4 TERM 3 TERM 3
TERM 4 TERM 4

Date Date
Name of Evaluator Class Name of Evaluator Class
Evaluated Evaluated

CERTIFICATE OF DELOADING Other Deficiencies

With certificate of Deloading Not deloaded Period of deloading is wrong
No Certificate of Deloading Withdrawn / resigned / Format is wrong
Name not on certificate terminated Others:

EVALUATION E-Form Study Plan

No E-Form
Term: __________________ Invalid Signature
Start Month: _____________ Invalid Copy
End Month: ______________ No Date on E-Form
E-Form Date: ____________
Grades
Term: __________________ No Grades
Start Month: _____________ Invalid Signature
End Month: _____________ Invalid Copy
E-Form Date: ____________ Grades for Verification
With INC Grade
With Failing Grade
No Study Plan on File
Did not follow submitted
study plan
Invalid Signature
Missing elements (units/
subjects / name of student)
Others
With Retaken Subject and
needs proof of payment
Needs Certification for
Mismatch

REMARKS: