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Request For Clearance Form: Surname First Middle Title

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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Cherrell Lynch
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68 views2 pages

Request For Clearance Form: Surname First Middle Title

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.

Uploaded by

Cherrell Lynch
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
Download as pdf or txt
Download as pdf or txt
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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:

_________________________________________________________________________________________________________

_________________________________________________________________________________________________________

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