Republic of the Philippines

DON HONORIO VENTURA STATE UNIVERSITY

Bacolor, Pampanga

PRE-REGISTRATION FORM
SECOND SEMESTER, ACADEMIC YEAR 2021-2022

I. DEMOGRAPHIC INFORMATION
Student Number Program of Study and Major : Year Level

2018005449
BSIT 4th

Name of Student

CUARTEROS RHODNEY GUIAO

Family Name Given Name Middle Name
Contact Details

09362725162 Rhodneycuarteros19@gmail.com

Primary Mobile Number Secondary Mobile Number Active Email Address

II. ENROLLMENT DETAILS

Credit Schedule/
Course Code Course Title Units Section Room
OJT Practicum for Information Technology 6 BSIT4A

By signing this document:

1. I fully understand and agree that the information above are true and correct; and that any false statement on this
document (as well as on the supporting documents) constitutes a perjury and could result in denial of the registration
and disciplinary proceedings with sanction as per the Don Honorio Ventura State University (the “University”) policies;
2. I am fully aware and understand that registration/enrollment in any course for the abovementioned academic period is
allowed only upon passing the pre-requisite(s) of the said course (if any); a course registered/enrolled in violation of
this rule will not be given any credit regardless of the grade obtained;
3. I authorize the University to collect and process any information declared herein with utmost confidentiality; and
4. I allow the University to disclose the collected information to its affiliates and lawful third parties for legitimate
purposes only.

Signature over printed name of Student Date signed by the Student

February 22, 2022

Cuarteros, Rhodney, G.

--------------------------------------------------------FOR DHVSU PERSONNEL ONLY---------------------------------------------------------

Recommending Approval
By signing this document I, hereby, declare that I have fully assessed the status of the student and advised him/her
with the appropriate courses to enroll in the academic period stated above.

Signature over printed name of Program Chairperson

Date recommended for approval

Approved by Date approved

 Signature over printed name of College Dean

DHVSU-QSP-REG-001-FO001-R00

DON HONORIO VENTURA STATE

UNIVERSITY
Villa de Bacolor, Pampanga

ADDING, DROPPING, CHANGING

FORM
PROCEDURE:
1. Accomplish form and submit it with the COR to the Program Chair for advising and approval from the
Dean.
3. Approved forms will be forwarded to the OUR by designated person.
4. Staff in the OUR will encode and print the updated COR.
5. Updated COR will be endorsed to the College Dean for distribution.

Name: Rhodney G. Cuarteros Academic Year- 2021-2022

Student Number: 2018005449
Academic Term
College: CCS Course: BSIT First Sem/Tri
/ Second Sem/Tri
Third Trimester

Feb/22/2022 Summer
Student Signature Date
SUBJECT TO BE
ADDED
Subject Code DESCRIPTIVE TITLE Unit/s Section
ITELEC 4 Integrative Programming Technologies 2 3 3-b

SUBJECT TO BE
DROPPED
Subject Code DESCRIPTIVE TITLE Unit/s Section

SUBJECT TO BE
CHANGED
FROM TO
Subject Code Units Section Subject Code and Units Units Section

Department Chair Dean/Director University Registrar

STUDENT'S
COPY
Name: Rhodney G.
Cuarteros Student Date: Feb/22/2022
#:2018005449

SUBJECT TO BE
ADDED
Subject Code DESCRIPTIVE TITLE Unit/s Section
ITELEC 4 Integrative Programming Technologies 2 3 3-b
 SUBJECT TO BE
DROPPED
Subject Code DESCRIPTIVE TITLE Unit/s Section
 SUBJECT TO BE
CHANGED
FRO T
M O
Subject Code Unit/s Section Subject Code Unit/s Section

Department Chair Dean/Director University Registrar

DHVSU-QSP-REG-001-FO002-R00