Verification Slip

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NAME OF SCHOOL/INSTITUTION

VERIFICATION SLIP

TO: CAMSUR PROVINCIAL GOVERNMENT SCHOLARSHIP OFFICE

NAME OF STUDENT:
COURSE/YEAR LEVEL:

PLS CHECK:

Presently enjoying other scholarship


Type:
NOT enjoying any scholarship

VERIFIED/ATTESTED BY:

SCHOOL SCHOLARSHIP COORDINATOR/ADMISSION

________________________________________________________________________________

Republic of the Philippines


PROVINCE OF CAMARINES SUR
Provincial Capitol Complex, Cadlan, Pili

___________________________________________
NAME OF SCHOOL/COLLEGE/UNIVERSITY

____________________________________________
ADDRESS

Name of Student: Age: ________ Sex: __________ [ ] OLD [ ] NEW


Complete Address: Contact No:
Parent/Guardian: Contact No.
Couse: Birthday:

Year/Grade Level ( ) SY ( ) Semester: [ ] First [ ] Second


[ ] Third [ ] Summer

SUBJECT CODE SUBJECT DESCRIPTION UNIT AMOUNT

TOTAL

STUDENT’S NAME AND SIGNATURE SIGNATURE OF REGISTRAR/COLLEGE DEAN

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