The Clearance Form Is Supposed to Be Completed in Full by the Designated Officers in The

F I N A L C L E A R A N C E F O R M

The Clearance Form is supposed to be completed in full by the designated Officers in the spaces provided. (It is the responsibility of the student to ensure that it is completed).

STUDENT NAME: ______ID NO: ______

DEGREE & MAJOR: ______YEAR: ______TO: ______

1. LIBRARY

I certify that the above named has returned all books or property belonging to the

Library. (In case of loss or damage state item ______

______and value KShs. ______).

Signed: ______Date:______

Head Librarian

2.  STUDENT AFFAIRS

(a)  Housing

I certify that the above named has returned all the belongings to the

Hostels. (In case of loss or damage state item ______

______and value KShs. ______).

Signed: ______Date:______
Housing Officer

(b)  (i) Graduation Dress

I certify that the above named has returned Gown/Cap/Hood belonging

to the University. (In case of loss or damage state item ______

______and value KShs. ______).

Signed: ______Date:______
Graduation Advisor

(ii) Degree Completion

I certify that the above named has completed all degree requirements as per his/her major.

Signed: ______Date:______
Graduation Advisor

(c)  Student Center

I certify that the above named has surrendered all equipment belonging

to the Sports Section. (In case of loss or damage state item ______

______and value KShs. ______).

Signed: ______Date:______
Sports & Activities Coordinator

(d)  Disciplinary

I certify that the above named has no pending disciplinary case(s).

Signed: ______Date:______
DVC-Student Affairs

(e)  Equipment

I certify that the above named has surrendered all equipment belonging

to the Student Affairs. (In case of loss or damage state item ______

______and value KShs. ______).

Signed: ______Date:______
DVC-Student Affairs

3. HEALTH SERVICES

I certify that the above named has no pending medical bills to the Health Services

and has returned all property. (In case of any bills, state below

KShs. ______).

Signed: ______Date:______

Medical Officer

4. ALUMNI AFFAIRS OFFICE

I certify that the above named student has registered as an Alumni.

Signed: ______Date:______

Alumni Officer

5.  CAFETERIA

I certify that the above named student has/has no outstanding balance in the

Cafeteria. (In case of any bills, state below

KShs.______).

Signed: ______Date:______

Cafeteria Manager

6. BUSINESS / ACCOUNTS

I certify that the above named has paid all outstanding charges owing to the

University and is hereby cleared to receive all Degree Certificates and

Testimonials.

Signed: ______Date:______

For: DVC-Finance & Administration

7. REGISTRAR

a)  Exit Survey Form completed:

Signed: ______Date______

Registrar or designee

b) This is to certify that the above named has been cleared of all University

obligations and is therefore entitled to release of Degree Certificate and

Testimonials.

Signed: ______Date:______Registrar