STUDENT APPLICATION FORM

Complete Name (Surname, Given Name, Middle Name):

GARGARAN, OLIVER PEÑAFLORIDA
Date of Birth: Gender:
July 10, 2005 MALE
PERSONAL

Programs Applied For:

☐ Bachelor of Science in Marine Transportation (BSMT)
☑ Bachelor of Science in Marine Engineering (BSMarE)
Place of Birth:
kauran ampatuan maguindanao
Civil Status: Religion: Age: Height (cm): Weight (kg):
Single Roman Catholic 17 165 54
Address: Mobile Number: Telephone Number:
block 19 lot 7 beverly homes phase 1 hugo perez Trece Martires City, Perez (+63) 905-143-9360 09952952420
(Lucbanan), Trece Martires City, Cavite Email:
oliverpgargaran@gmail.com
EDUCATIONAL BACKGROUND

SENIOR HIGH SCHOOL

Name of School:
Strand: Address: Year of Graduation: GWA:
Sto. Niño De Praga Academy of La
HUMSS La Paz Homes II Trece Martires City, Cavite 2022-2023 90
Paz Homes II, Inc.
COLLEGE
Name of School: Address: Year of Graduation: Last Semester Attended:

School Achievements/Honors/Awards: Skills (welding, computer programming, etc.):

Organizations/Affiliations/Fraternity/Sorority/Extra-curricular activities involved in:

Father's Name: Age: Occupation/Company: Monthly Income: Contact Number: Address:

GARGARAN, GERARDO Housewive 5,000-10,000 (+63) block 19 lot 7 beverly homes phase 1
hugo perez Trece Martires City Cavite
VILLAFLOR 995-295-2420
Mother's Name: Age: Occupation/Company: Monthly Income: Contact Number: Address:
PEÑAFLORIDA, RITA MAE CARETAKER 30,000-40,000 (+63) block 19 lot 7 beverly homes phase 1
hugo perez Trece Martires City Cavite
LARDERA 995-295-2420
FAMILY BACKGROUND

Other Sources of Income: Monthly Income from other sources:

none 5,000k-10,000k
Siblings:
Name Date of Birth Civil Status Education Level Occupation/Company
EKATERINE GERIMAE P. Oct 16,2008 Single 7
GARGARAN
TITO ISIDORE P. GARGARAN Nov 19,2011 Single
Relatives who are seafarers (if applicable):
Name Company Position Relations
Contact Person in Case of Emergency:
Complete Name: Relationship:
GARGARAN, GERARDO
Complete Address: Contact Number:
block 19 lot 7 beverly homes phase 1 hugo perez Trece Martires City (+63) 995-295-2420
Please put a checkmark if you have been diagnosed for or experienced any of the following conditions?
☐ ADHD ☐ Color Blindness (please go to link: https://www.colorlitelens.com/ishihara-test)
☐ Heart Disease ☐ Diabetes ☐ Unable to do strenuous activities ☐ Others :
How much of school fees are you able to pay per trimester?
15,000k-40,000k
What are your primary sources to finance your studies at MMMA?
☐ Personal Savings     ☐ Parents'/Relatives' Support     ☐ Student Loan     ☐ Others :
HOW DID YOU LEARN ABOUT MMMA?
☑ Social Media ☐ Referral / Recommendation ☑ Career Talk
☐ Invited by Letter ☐ Promotional Posters / Tarps ☐ Other:
REFERRED BY: (Specify)

What city do you prefer to take MMMA Entrance Examination?

dasmariñas cavite

  I hereby certify that the above information are true and correct, and I willingly consent to process the foregoing
data. Any material misrepresentation of facts herein will be sufficient grounds for disqualification.
  MMMA and the Applicant recognize the responsibilities under Republic Act No. 10173, also known as the Data
Privacy Act of 2012, with respect to data collection, storing, accessing and/or processing of Personal Data. The Personal
Data in this form will only be used for admission and selection processing.

Applicant's Signature over Printed Name

Documentary
Program Minimum Education Qualifications
Requirement
BS Marine *Graduate or graduating of any *17 to 21 years old. *For SHS Graduate:
Transportation Senior High School Program with *Single (never been married; no 1.Form 138 (Certified
BS Marine GWA of at least 83%, with no child/children) True Copy)
Engineering final grade lower than 80% in *At least 162.5 cm (male) or 157.5 cm 2.Certificate of Good
any subject. (female) in height. Moral Character.
*College level with grades not *Physically fit, no pre-existing medical 3.PSA Authenticated
lower than 83% in any subject. condition or taking maintenance Copy of Birth Certificate.
medicine (heart, respiratory, diabetes,
hypertension, color blindness, ADHD, *For College Level:
etc). 1.Certification of Grades
from previous school.
2.Honorable Dismissal
from the previous school
3.PSA Authenticated Birth
Certificate