Republic of the Philippines © CEBU TECHNOLOGICAL UNIVERSITY Ee gus Balamban Campus jy stars ‘Student Affairs Office GUIDANCE OFFICE - DAY PROGRAM APPLICATION FORM FOR ENTRANCE TEST | agree to provide a complete and accurate information asked herein and allow the University to process it for any legal Purpose. Withholding or giving false information will make me ineligible for admission of subject to dismissal from the university. If ‘admitted, | agree to abide by the policies, rules and regulations of Cebu Technological University GINA EAN ABELLA February 23,2023 Signature over Printed Name of Student-Applicant Date Signed W. i Tracking Code: CTLuzGOH9s-21. Examinee Number: 23-126-0018742 BACHELOR IN INDUSTRIAL TECHNOLOGY Application for: MAJOR IN CIVIL TECHNOLOGY day [J evening Program Major Application for: [|Senior High School Graduate ["] Ttensfetee [] shifter [] Retunee [CJAts Graduate [7] High senoo! Graduate (old curriculum) If Senior High School Graduate: Track/Strand: ACADEMIC: HUMANITIES AND SOCIAL SCIENCES (HUMSS) - 119027700003 Learner's Reference Number (LRN) 1.Name: ABELLA GINA JEAN Family Name First Name Middle Name 2.Gender; []Male Ij Female 3.Age:__19__4. Date of girth: November 22,2008 5. Citizenshi FILIPINO 6. Civil Status: Single []Married [_] Separated aro oisricr 7. Home Address: NANGLA BALAMBAN CEBU District _“cacavoan __Zipeode_6041 Email address: abella.ginajane@gmail com Telephone No. 09937649651 Mobile/ Cell Phone N 09937649651 8, Secondary Education ‘Complete Name of Last School Attended: __NANGKA NATIONAL HIGH SCHOOL Year Graduated: __ 2023 ‘Address of School: NANGKA BALAMBAN CEBU 9. College Education (ForTransferees/Shiters/Returnees) Degree/ Course: School: No. of Units Earned Inclusive School-year/s: From : To To be Filled-out by the college/department. Grade Point Average: 85 _ Screened by:__system generated Date of Screening: February 23.2023 Endorsed for entrance test.