Republic of the Philippines

CENTRAL BICOL STATE UNIVERSITY OF AGRICULTURE

San Jose, Pili, Camarines Sur

DOCUMENT ACKNOWLDGEMENT RECEIPT

___Semester SY 20___ - 20___
Note: This form should be submitted to the Chairpersons’ Office on the schedule as agreed

Subject: ________________________ Year & Sec.: ______

Document/s Received: (Please check all that apply)
_____ Worksheet/Quiz/
_____ manual/ hand outs
_____ Examination (Period: ____ Midterm ____Final)
_____ Project
_____ Syllabus
_____ Others (specify) ______________________________________________
By signing below, I acknowledge receipt of the foregoing document/s.
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RECEIVED RECEIVED
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_______________________________
Signature over Printed Name of Faculty

Noted:

________________________________ _______________________________
Signature over Printed of Program Chair Signature over Printed of CDE Dean
CBSUA-PIL-F-CDE-23
Effectivity Date: January 3, 2017 Rev: 0 Page 1 of 1