Clearance Form for Summer Students

UMMER  

Form Reg. 13A
BAHIR DAR UNIVERSITY
COLLEGE/FACULTY/INSTITUTE/SCHOOL OF ________________
CUSTOMERS RELATION & INFORMATION PRODUCTION CASE TEAM
SUMMER STUDENT CLEARANCE SHEET
Purpose:
If you want to have a healthy relationship with the university, it is very important to the student to 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      _______
Faculty         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 __________________    Forced withdrawal ___________________
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.  Student’s Café  ____________________      _____________
4.  Housing office   ____________________      _____________
5.  Finance case team ____________________      _____________
Date of receiving the clearance, if necessary including the I.D card, by  Information and Documentation Case 
Worker  of CRIPCT.      ______/______/______ E.C
dd       mm yy