Clearance Form for Postgraduat Students

Form Reg. 13 Bahir Dar University College/Faculty/School/Institute of /_________________________________ Office of Customers Relation and Information Production Case Team Regular Postgraduate Student Clearance Sheet Purpose: If you want to have a healthy relationship with the university, it is very important to the student to complete this if you want to have a healthy relationship with the university, it is very important to the student to complete this clearance form properly & return it to the University registrar before you leave the university campus what ever the reason may be. Only with the proper termination below can official transcripts, letter of enrollment, student copy, or honorable dismissal be issued. Readmission to any unit of the university will be considered only if proper termination is certified by the University registrar. Procedures: 1. Complete the firs part of this form. 2. Have terminal interviews with your academic Advisor. 3. Obtain the signatures designated below, showing that you have returned university property. 4. Return this form to the Office of the Registrar on time. 5. This form becomes part of your permanent University file and record. Academic year _________ E.C Semester ___________ Personal Data _________________ _____________ _______________ _______ Name of the Student Fathers Name G/Fathers Name Sex ______________ _____________ I II III IV V College/Faculty/School/Institute Program Year of study (circle it I.D. No Reason for clearing from the University (put ‘X’ in the appropriate place) End of academic year _________ Academic Dismissal _____________ Disciplinary case _______________ Withdrawing due to health/family problem _____ Graduation __________________ If you have reason other than these, please specify it _______________________________ Date of application by the student ______/_____/_____/ E.C ________________ mm dd yy Signature of the application advisor’s reason to approve student’s clearance, if the reason is other than end of academic year ______ ___________________________________________________________________________________ ____________ _______/______/______E.C ____________ Advisor’s name mm dd yy Signature Pleas obtain signatures from the following Full name Signature 1. Library ____________________ _____________ 2. Book Store ____________________ _____________ 3. Finance case team ____________________ _____________ Date of receiving the clearance, if necessary including the I.D card, by the Information and Documentation compilation case worker. ______/______/______ E.C dd mm yy Regular