Republic of the Philippines

Laguna State Polytechnic University

Province of Laguna

APPLICATION FOR COLLEGE ENTRANCE TEST

Instructions: READ ADMISSION AND APPLICATION REQUIREMENTS AT THE BACK PAGE

Fill in all the required information. DO NOT leave an item blank. if item is not applicable, indicate "N/A".

STATUS OF APPLICANT

☑Freshmen □Transferee □Returnee □ Shifter □ Continuer

PERSONAL INFORMATION
Name Violeta Ezekiel De Guzman D
AGE DATE OF BIRTH SEX CIVIL STATUS CITIZENSHIP
18 2004-02-18 ☑ Male ☑ Single ☑ Filipino
COMPLETE PERMANENT MAILING ADDRESS
(HOUSE NUMBER) (Street/Subdivision) (Barangay) (Municipality/City) (Province) (Zipcode)

Blk 1 lot 12 Jesus Aking Panginoon Ville Pook Sta Rosa City Laguna 4026

MOBILE NUMBER TRACK/STRAND INTENDED First Choice: Bachelor of EMAIL ADDRESS

COURSE Science in Business
Administration

09219933179 Second Choice: Bachelor of violetaezekielfeb18@gmail.com

Science in Entrepreneurship
EDUCATIONAL ATTAINMENT
NAME OF SCHOOL SCHOOL ADDRESS TYPE OF SCHOOL YEAR ATTENDED
ELEMENTARY: 259 Sergio Osmeña St. ☑ Public 2016
Cabuyao Central Elementary Cabuyao, Laguna
School
HIGHSCHOOL: Limcaoco Subd. Brgy Tres, 4025 ☑ Public 2020
Cabuyao Integrated National High Cabuyao
School
SENIOR HIGH SCHOOL: Sta. Rosa Homes Subdivision, ☑ Private 2022
Queen Anne School Of Sta. Rosa Brgy. Dita, Santa Rosa Laguna
And Dasmariñas
COLLEGE: (For Transferee) □ Public From:
□ Private To:

Course REASON FOR TRANSFERRING:

RAW SCORE: GWA: GUIDANCE COUNSELOR/GUIDANCE PERSONNEL: DATE FILED:
June 22, 2022
LRN: 108239090352 SIGNATURE OF THE APPLICANT:

Application Number: LSPU ENTRANCE TEST PERMIT

To be filled-out by applicant
Applicant's Name: Ezekiel de Guzman Violeta
Intended Course: Bachelor of Science in Business Administration
SCHEDULE OF EXAMINATION
Date: ____________ Approved:
Time: ____________ ___________________________________
Room No: ____________ Examiner's/Proctor's Signature