06/18/2019 

 
EASTERN VISAYAS STATE UNIVERSITY 
BURAUEN CAMPUS 
  
APPLICATION FOR GRADUATION 
S.Y. 2018-2019 
 
 
Student Number: 2018-25376  Course: BSEd-TLE  
Year Level: 1st Year Section: 1B Department: Education 
 
PERSONAL DATA 
Lastname: REFUERZO  
Firstname: RAFFY   
Middlename: TORRES 
Age: 28 Birthday: 1990-12-15 Email Address: hottaraffy@gmail.com   
Civil Status: Single Mobile Number: 09466474138 Gender: Male
 
PERMANENT/RESIDENTIAL ADDRESS 
House/Street Number:  Street Name:   
District/Barangay: SAN DIEGO  Municipality/City: BURAUEN  Province: LEYTE Region: VIII
Postal/Zip Code: 6516 
 
PARENTS’ INFORMATION 
(Father’s Name) Lastname REFUERZO Firstname PABLITO Middlename ALERE 
(Mother’s Maiden Name)Lastname TORRES  Firstname CRISTITA  Middlename OMOTO 

CONTACT PERSON IN CASE OF EMERGENCY 

(Guardian’s Name) 
Lastname: GABIETA Firstname: RICHA Middlename REFUERZO 
Complete Address: SAN DIEGO ST., DIST.9, BURAUEN, LEYTE 6516 
Contact Number: 09108975594 

NSTP-CWTS COMPLETED 
NSTP Semester School Year Grade Remarks  
CWTS-1 1​st  2017-2018 1.5 Dropped  
CWTS-2 2​nd 2018-2019 1.1 Excellent  
 
I certify that the above information given are true to the best of my knowledge. 

Applicant Signature:

RAFFY TORRES REFUERZO  

Signature Over Printed Name
   
Checked and Found Correct by: 
 
____________________________________ 
    NSTP-CWTS Instructor 
Noted & Verified by:   
 
  IAN CONAN B. JUANICO        
NSTP Coordinator, EVSU-Burauen Campus 

Date Accomplished: 06/18/2019 02:38:05 

 
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