Lyceum of the Philippines University – Manila

Senior High School

APPLICATION FOR REMEDIAL CLASS

Semester:  First  Second Academic Year:

Name of Student: Date:
Name of Adviser: Grade and Section:
Subject Teacher: Subject Code:
1st/3rd Quarter Grade: 2nd/4th Quarter Grade: FINAL GRADE:
Reason for failing:
(indicate
deficiency/ies)

Signature of Subject Teacher: DEADLINE:

Submitted by:
_________________________ _________________ __________________________ _________________
Name and Signature Date Parent’s Name and Signature Date

Approved by:

__________________________ _________________
Curriculum Coordinator Date

Noted by:

_________________________ _________________
Principal Date

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CERTIFICATE OF RECOMPUTED FINAL GRADE

Name of Student :
Grade Level :
School Year :

Learning Area Final Grade Remedial Class Mark Recomputed Final Grade

Prepared by : Date :
Remedial Class Teacher

Noted by : Date :
School Principal

Received by : Date :
Division Office