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Client Information Sheet
Kindly fill up this form when requesting for consultation with our statisticians
Email address *
Name *
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Course *
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Institution *
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Email address *
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Contact No. *
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Choose the type of service to avail *
Project Adviser/Leader *
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Source of Funds *
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General Objective/Main Problem of the Study *
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Specific Objective/Main Problem of the Study *
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Available date and time for consultation/short course/workshop:
You can indicate more than 1 schedule (date and time)
Date 1
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Date 2
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Date 3
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Time 3
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Please deposit/pay the amount of PhP_________ to:
Unionbank/Cebuana Lhuilier/Bayad Center/Prince Retail
Merchant Name: University of San Carlos
Reference: 0614
Campus No.: 5

University of San Carlos (c/o Teller)
Payment slip: Others - Statistics Center 0614

Terms and Conditions
1. The USC Statistics Center reserves the right to refuse its offer of consulting/statistical services if it is
felt that the requested services are outside of the available expertise of the consultant/statistician.
Further, the USC Statistics Center has the right to discontinue its statistical analysis service at any
time due to nonpayment of charges or for other concerns deemed reasonable as assessed by the
coordinator. This service can be resumed after charges have been paid or other problems have been
resolved.
2. The minimum charge must be paid before any service is rendered. Please bring or email the official
receipt as proof of payment.
3. Client must give the consultant/statistician at least 24 hours’ notice thru email _______________ or
telephone call ____________________ if they will be unable to make an appointment.
By signing, I have read and understood these terms and conditions:

__________________________________
Signature over printed name

Date: _____________________________

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