Republic of the Philippi 2-C President Ramon Magsaysay ‘Sidi (Fomeriy Ramon Magsaysay Technolog ae tba, Zambales DATE: Ma __Passport Size LMENT FORM 2-¢ 10 Picture (Old Students) Date of Application: ‘A. Student's Personal Information (To be filled out by the Student-Applicant) NAME: Family Name First Name ‘Middle Name ADDRESS: (Gerangey) (Municipal) (Province) (@p Code) Contact Number (Required) Email Address (Required) Date of Birth: ae: Gender: Pace of Birth Civ Statuss( )SoloParend_( )Married (Single ( )Wdow Nationality: Religion: ParenGuardian Relation to Guardian Address of Guardian Contato Occupation of ParentiGuardion ‘Average income of the Family, [_] weethentoa00 [] 0000.70 [-] zocortesec00 © []s0001 to 0.000 1 rmare nen 50.000 FE] mere than 100,00 OTHER IMPORTANT INFORMATION: Kindly check the box applicable to you. [—] PWD [indigenous Peoples t?) — [—] student from Depressed Areas Add! information relevant to answer: B. Last Term of Attendance at PRMSU / Course you intend to take at PRMSU: Last term attendance at PRMSU: ‘TermiSemester: ‘Academic Year: Course: Major: (Curriculum Year ‘Are you going to enrol in your previous course taken at PRMSU: ( ) Yes (No answer is NO, what course are you going to take up: Please accomplish / present a copy of PRMSU-ASA-OURSE 3 (Shifting Form), and submit it together with this form. DATA SUBJECT CONSENT FORM In compliance with RA 10173. Data Privacy Act [OPA of 2012, and its Implementing Rules and Regulations (IRR, |authorize PRESIDENT RAMON MAGSAYSAY STATE UNIVERSITY to collect and process my personal information with utmost confidentiality. ely allow PRNISL to dclose my personal information to alates and awful third parties for legate purposes only 25 personally specified below: [Osehoarshin crantors 2] senefactors []employers [] Researchers [—] Former schoo! [] industries, Companies, Fs [unieast [ Cotters Pease sect towise grant PRESIDENT RAMON MAGSAYSAY STATE UNIVERSITY to collet, process and disclose my personal information for a period of ve (5) years only. “iarature over printed name of Appiant Date ‘Action Taken: Approved Disapproved. Conditional rinied Name ofthe Accepting De ‘Signature of he Accepiing De CREDENTIALS SUBMITTED: To be checked and signed by the Registrar's personnel (() Updated Evaluation Form / Program of Study (photocopy) Signature over printed name Reflecting all subjectscourses credited ‘of Applicant [NOTE: ithe credentiats | submitted are confirmed tobe spurious, my admission wil be revoked. ‘admitted, agree to abide by the polices rules and regulations ofthe President Ramon Magsaysay tate | Univers Date (Credentials submitted are complete {) Credentials submitted are incomplete. Please accomplish and submit Form 12-A (Promissory Note) together with this form. Recommended for Enrolment Date NoTeD: JOSE D, DOCUYANAN University Regisrar Wot Pages Name of Form: Code: Version: 03 | may 18,2020 Tort Enrolment Form 2-¢ (Old Studenis) ~PRMSU-ASA-OURSF 2.¢