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    Request For Clearance Form: Surname First Middle Title

    Uploaded by

    Cherrell Lynch
    This document is a request for clearance form containing personal details such as name, date of birth, contact information, residential and mailing addresses, institution, programme, and module details. The form is for either first time GATE recipients to provide acceptance documentation, or prior GATE recipients pursuing a new or continuing programme to provide completion documentation or grade slips. The private tertiary level institution section is to be completed if accepting a student to a new programme.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Request For Clearance Form: Surname First Middle Title

    Uploaded by

    Cherrell Lynch
    49 views2 pages
    This document is a request for clearance form containing personal details such as name, date of birth, contact information, residential and mailing addresses, institution, programme, and module details. The form is for either first time GATE recipients to provide acceptance documentation, or prior GATE recipients pursuing a new or continuing programme to provide completion documentation or grade slips. The private tertiary level institution section is to be completed if accepting a student to a new programme.

    Original Description:

    gate

    Original Title

    GATE Clearance Form

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    This document is a request for clearance form containing personal details such as name, date of birth, contact information, residential and mailing addresses, institution, programme, and module details. The form is for either first time GATE recipients to provide acceptance documentation, or prior GATE recipients pursuing a new or continuing programme to provide completion documentation or grade slips. The private tertiary level institution section is to be completed if accepting a student to a new programme.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    49 views2 pages

    Request For Clearance Form: Surname First Middle Title

    Uploaded by

    Cherrell Lynch
    This document is a request for clearance form containing personal details such as name, date of birth, contact information, residential and mailing addresses, institution, programme, and module details. The form is for either first time GATE recipients to provide acceptance documentation, or prior GATE recipients pursuing a new or continuing programme to provide completion documentation or grade slips. The private tertiary level institution section is to be completed if accepting a student to a new programme.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    REQUEST FOR CLEARANCE FORM

    NAME:

    ________________________________________________________________________________________ ________________
    Surname
    First
    Middle
    Title

    DATE OF BIRTH:

    ____________________________

    Gender:

    Female

    Male

    (dd/mm/yyyy)
    NATIONAL ID NO: ____________________________

    CONTACT NO:

    ________________________ ____

    E-MAIL ADDRESS: _______________________________________

    RESIDENTIAL
    ADDRESS:

    _________________________________________________________________________________________________________

    MAILING
    ADDRESS:

    ________________________________________________________________________________________________________

    INSTITUTION:

    ________________________________________________________________________________________________________

    PROGRAMME:

    ________________________________________________________________________________________________________

    LEVEL / YEAR:

    _________________________________________________________________________________________________

    MODULES (if applicable):

    _________________________________________________________________________________________________

    MATRICULATION ROUTE:
    Normal
    (Applicable for ACCA and CAT Only)

    Mature

    Please choose one of the following options depending on your registration status:
    1.

    FIRST TIME GATE RECIPIENT:

    OR
    2.

    PRIOR GATE RECIPIENT


    NEW PROGRAMME

    PROGRAMME JUST COMPLETED: __________________________________________

    LEVEL/ YR/ PROGRAMME JUST COMPLETED: ________________________________

    OR
    CONTINUING PROGRAMME

    Page 1 of 2

    Before submitting your GATE Clearance Form to your Institution please verify that you have attached the following documents:
    First Time GATE Recipients (One of the following)
    GATE Clearance Form stamped and signed by the local GATE Funded Tertiary Level Institute (TLI)

    OR
    Copy of Acceptance Letter from the GATE Funded Tertiary Level Institute

    Prior GATE Recipients pursuing a New Programme


    GATE Clearance Form stamped and signed by the local GATE Funded Tertiary Level Institute

    OR
    Copy of Acceptance Letter from the GATE Funded Tertiary Level Institute
    Proof of completion of your previous GATE Funded Programme (Copy of Certificate or Transcript)

    Prior GATE Recipients continuing to pursue the same Programme

    Copy of Grade Slips / Transcript of all exams attempted for the programme

    SIGNED:

    ______________________________

    DATE:

    ________________________________

    THIS SECTION IS TO BE COMPLETED BY THE PRIVATE TLI FOR STUDENTS PURSUING A NEW PROGRAMME IF THE STUDENT HAS NOT
    BEEN PROVIDED WITH AN ACCEPTANCE LETTER

    ____________________________________________ has been accepted to pursue ___________________________________________________


    (Student Name)
    (Programme Name and Level)
    at _________________________________________________________________ for the start date ________________________________________
    (Institution Name)
    (Indicate Start Date of Programme)

    Authorised Signature: __________________________________

    Institution Stamp: ________________________________________________

    MINISTRY USE ONLY


    NEW STUDENT;

    APPROVED FOR CLEARANCE: Yes

    RETURNING STUDENT:

    STUDENT ID NO.: ________________________

    DATE:

    No

    PROCESSED BY:

    ________________________________________

    ________________________________________

    COMMENTS:

    _________________________________________________________________________________________________________

    _________________________________________________________________________________________________________

    Page 2 of 2

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