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Region I

Schools Division Office Urdaneta City


DON ALIPIO FERNANDEZ SENIOR INTEGRATED SCHOOL
Urdaneta City, Pangasinan 2428
075 204 0131 – 32 | Telefax: 075 568 3054

CLEARANCE FORM
( GR A D E 1 1 )

This is to certify that ______________________________ has been cleared


with his/her academic and financial accountabilities of this school for S.Y. 2016-
2017.

MARK JOSEPH N. COMETA GUILMOR R. PADILLA


School Paper Adviser School Property Custodian

Subject Teachers: Subject Signature


JEFF ADLOUIE C. SUAREZ Technical Drafting _____________
HARRY LAWRENCE V. PASION Reading and Writing Skills _____________
Creative Nonfiction _____________
Pagbasa at Pagsusuri sa _____________
Pananaliksik
Physical Education 2 _____________
Adviser:
Statistics and Probability _____________
VICTOR E. CORPUZ Practical Research 1 _____________
Politics and Governance _____________
Social Science _____________
Other Responsibilities:
Portfolio _____________
Miscellaneous _____________
PTA Project _____________
Junior-Senior Prom Fee _____________
Student Project _____________

Noted:
CHARLIE M. CLEMENTE
Principal IV

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