UREG-QF-02

Republic of the Philippines

CAVITE STATE UNIVERSITY
Don Severino delas Alas Campus 1x1 picture
Indang, Cavite

STUDENT INFORMATION SHEET

Name (please print) Trias Jamaica Calumpiano

Last Name First Name Middle Name

Home Address San Gabriel Bagumbayan General Trias Cavite

House No. & Street Barangay Town Province

4767367
Landline No. ___________________________ 09958197400
Cellphone No. _________________________

trias.jamaica@gmail.com
E-mail Address _________________________________________________________________

Course _______________________________ Section ______________________________

Student Classification: / / New /✘/ Continuing / / Transferee / / Cross Enrollee

/ / Shiftee from ____________ / / Returnee

Registration Status /✘/ Regular / / Irregular / / Temporary

12/22/2000
Date of Birth ________________________ Noveleta, Cavite
Place of Birth ______________________________
19
Age ______ Female Religion ___________
Sex _______ Catholic Filipino
Nationality ________Civil Single
Status __________

Educational Background

General Artemio Ricarte Memorial School

Elementary _____________________________________________________________
2013
Year Graduated _______________ /✘/ public / / private
Poblacion, General Trias, Cavite
Address ________________________________________________________________

Luis Y. Ferrer Jr. Senior High School

High School _____________________________________________________________
2019
Year Graduated _______________ /✘/ public / / private
South Square Village, Pasong Kawayan II, General Trias, Cavite
Address ________________________________________________________________

For Transferees/Cross Enrollees

School Last Attended ______________________________________________________
Address ________________________________________________________________
==========================================================================
Jose A. Trias
Parent/Guardian ________________________________________________________________
100 Bagumbayan, General Trias, Cavite
Address ______________________________________________________________________
None
Occupation ____________________________________________________________________
4767367
Landline No._____________________ 09351159137
Cellphone No. __________________________________

_____________________________
Signature of Student

V01-2018-06-05