POLYTECHNIC UNIVERSITY OF THE PHILIPPINES

OFFICE OF THE UNIVERSITY REGISTRAR

ADMISSION SERVICES
STA. MESA, MANILA

CAEPUP 2022 APPLICATION FORM

REFERENCE NUMBER: 2023-0067-3549 DATE OF APPLICATION: 02/23/2023
PERSONAL INFORMATION:
Complete Name: Antiporda, Eljay Carpio
Sex: FEMALE Height: 155 cm. Date of Birth: 04/13/2001

Civil Status: SINGLE Weight: 40 kg

CONTACT INFORMATION:
Contact Number/s: 09632249062
Email Address: eljayantiporda13@gmail.com
Address: 169 Sitio 1 Bahay Pare, Candaba, Pampanga, Brgy. Bahay Pare, CANDABA, Philippines (the)

IN CASE OF EMERGENCY, Please No fy:

Contact Number/s: 09310693805
Contact Person: Mary Jane C. Antiporda
Address: 169 Sitio 1 Bahay Pare, Candaba, Pampanga, Brgy. Bahay Pare, CANDABA, Philippines (the)

ACADEMIC INFORMATION (LAST SCHOOL ATTENDED):

Mode of Learning: Senior High School LRN 105929060018

School Name: Bahay Pare National High School

School Address: Sitio 2 Bahay Pare, Candaba, Pampanga
Year Graduated: 2021

EMPLOYMENT INFORMATION (OPTIONAL):

Company: Not Employed Contact Number/s: Not Applicable

Address: Not Applicable

ACADEMIC PROGRAM PREFERENCES:

1. BSPSY-BACHELOR OF SCIENCE IN PSYCHOLOGY

2. BS-ARCHI-BACHELOR OF SCIENCE IN ARCHITECTURE

3. BSID-BACHELOR OF SCIENCE IN INTERIOR DESIGN

4. BSIT-BACHELOR OF SCIENCE IN INFORMATION TECHNOLOGY

5. BSCE-BACHELOR OF SCIENCE IN CIVIL ENGINEERING

CONFORME:

APPLICANT’S SIGNATURE DATE

- - - - - - - - - TO BE FILLED UP BY AN AUTHORIZED PUP ADMISSION OFFICER - - - - - - - - -
REMARKS:

THIS IS AN AUTO-GENERATED COPY OF YOUR CAEPUP 2022 APPLICATION FORM • VOID IF TAMPERED • VALID ONLY For the First Semester, Academic Year 2023-2024
THIS FORM CONTAINS PERSONALLY IDENTIFIABLE INFORMATION. TO PROTECT YOUR DATA PRIVACY, PLEASE KEEP AND FILE THIS IN A SAFE LOCATION.
TRANSACT AND SUBMIT ONLY TO AN AUTHORIZED PUP ADMISSION OFFICER.

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