OFFICE OF THE UNIVERSITY REGISTRAR

APPLICATION FOR GRADUATION

(UNDERGRADUATE/GRADUATE)

Semester Applied for: (Check the appropriate box)

1st Semester, SY / 2nd Semester, SY 2021-2022 Midyear

[Please fill the needed information based on the Birth Certificate from PSA (NSO)]

NAME GALAS ALJON ADLAON

Last Name First Name Middle Name Name Extension

STUDENT BIRTH DATE

NUMBER
2018301481 (MMMMM DD, YYYYY)
MAY 31, 1999

CONTACT EMAIL
NUMBER
0946 974 4179 ADDRESS
s.galas.aljon@cmu.edu.ph

HOME POBLACION QUEZON BUKIDNON

ADDRESS
BARANGAY CITY/MUNICIPALITY PROVINCE

DEGREE/CERTIFICATE APPLIED FOR

(Check the appropriate box and then specify Program and Majors/Certificate)

BACHELOR BACHELOR OF SECONDARY EDUCATION

MAJOR MAJOR IN FILIPINO
MASTER
MAJOR

DOCTOR
MAJOR

CERTIFICATE IN AGRICULTURAL SCIENCE

CERTIFICATE IN TEACHING

SPECIAL COURSE
FIELD

TESDA
FIELD

COLLEGE REGISTRAR/REPRESENTATIVE SIGNATURE OF APPLICANT

(Printed Name and Signature )
JANUARY 13,
DATE RECEIVED DATE APPLIED
2022
OR NO
AMOUNT PAID
*APPLICATION FEE: DATE PAID

CMU-F-1-REG-008 31 March 2021 Rev. 1 Page 1 of 2

 GRADUATE STUDIES: ₱ 600.00
UNDERGRADUATE: ₱ 400.00

PRIVACY CONSENT

I hereby agree and consent that Central Mindanao University may collect, use, disclose and process my personal
information set out in this form and/or otherwise provided by me for the purpose of requesting school documents as stated
in the Data Privacy Act 2012 and other related data privacy policies.
The information will be only accessed by authorized university staff. I understand my data will be held securely
and will not be disclosed to third parties without my permission. I have the right to change or access my information. I
understand that when this information is no longer required, official university procedure will be followed to dispose my
data.
By signing below, I represent and warrant that I am the data subject and that I have read and agree all of the
above provisions.

ALJON A. GALAS JANUARY 13, 2022

Signature over printed name Date

ACKNOWLEDGE BY:

Signature over printed name Date

CMU-F-1-REG-008 31 March 2021 Rev. 1 Page 2 of 2