PRE-REGISTRATION FORM

(Write in BLOCK LETTERS)

SUMMER SEMESTER, ACADEMIC YEAR 2021-2022

STUDENT ID NO. 2018-312868

NAME VILLARUZ MARK GIL MURGUIA

(Last Name) (First Name) (Middle Name)

STUDENT TYPE New Old If old student, Year 1st 2nd 3rd last

DEGREE SOUGHT BS MECHANICAL ENGINEERING

GENDER MALE
BIRTHDATE OCTOBER 29, 1999 _
CIVIL STATUS SINGLE
RELIGION ROMAN CATHOLIC
NATIONALITY FILIPINO
ADDRESS BRGY. PAGBUNITAN SIGMA, CAPIZ
PHONE NUMBER 09317802089
PRESENT POSITION _________________________________
Position _________________________________
Agency _________________________________
Address _________________________________

In case of emergency:
Parent/Guardian GIL VILLARUZ
Address BRGY. PAGBUNITAN SIGMA, CAPIZ
Contact Number 09484249783
Email Address _________________________________

COURSES ENROLLED:

COURSE CODE COURSE TITLE UNITS

OJT ON-THE-JOB TRAINING (OJT) 3

TOTAL 3

__________________
Signature of Student
Registration Adviser ANACLETO M. CORTEZ, JR.
Date Assessed _______________________
Scholarship _______________________
 Document Type: Document Code INS-F01
FORM
ISO 9001:2015 Revision No. 00

Document Title: Effective Date June 25, 2018

PRE-REGISTRATION FORM Page 1 of 1

SUMMER SEMESTER/SUMMER, AY: 2021-2022

Name: MARK GIL M. VILLARUZ Sex: MALE Age: 21

Course and Year: BS MECHANICAL ENGINEERING
Address: BRGY. PAGBUNITAN SIGMA, CAPIZ
Parent/Guardian: GIL VILLARUZ

COURSE COURSE TITLE UNIT FACULTY

CODE CREDIT
OJT ON-THE-JOB TRAINING (OJT) 3

TOTAL 3

MARK GIL M. VILLARUZ

Name and Signature of Student

This is to certify that the student indicated above is qualified to enroll this
Summer Semester, Academic Year 2021-2021.

Noted: Received:

_ENGR. JOEL C. VILLARUZ, PhD_ ________________________

Program Coordinator/OIC-Dean Registrar