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Rev.

03 Republic of the Philippines


Aug. 1, 2019
SORSOGON STATE UNIVERSITY
Sorsogon City, Sorsogon 4700
Telefax: 056-211-0200
www.sorsu.edu.ph

ADMISSION TEST PERMIT


Tertiary Level

Period: First
_________________________
Semester A.Y. 2023-2024 Recent 2" x 2" colored ID picture
with white background

Applicant's Name: HISARZA


_________________________________________________________________
JAIRU HAJA None
Last Name First Name Middle Name Name Ext.
Address: ________________________________________________________________________
BURGOS, Casiguran, Sorsogon

Preferred SSC Campus:[X] Sorsogon City [ ] Bulan [ ] Magallanes [ ] Castilla

Course Choices: ____________________/______________________/_______________________


BSED - MATH BTVTED - AUTO _____________________________
1st Choice 2nd Choice 3rd Choice Applicant's Signature

Application Number: ____________________________


ADS23-173911 TEST SCHEDULE
Feb 11, 2023 1:00 PM SorSU Sor. City Tech Bldg. Rm 108
Date of Application: ____________________________
Jan 24, 2023 6:24 PM
Date & Time Venue Seat #
Examinee Number: ____________________________
SC23-106725 Reminders:
• Be at the testing center at least 15 minutes before the time.
Official Receipt: _________________Date: __________
• Bring this Test Permit, rubber eraser, pencils (Mongol #2), sharpener and ballpen.
• Cheating, impersonation and other forms of examination irregularity can be a
Registered by: ________________________________
ANNEBEL C. HERNANDEZ ground for disqualification for admission or dismissal, if admitted.

FM-ADS-002A Received by: ___________________________ Jan 24, 2023 6:25 PM


Date: ___________________
--------------------------------------------------------------------------------------------------------------------------------------------------------
Rev. 03 Republic of the Philippines
Aug. 1, 2019
SORSOGON STATE UNIVERSITY
Sorsogon City, Sorsogon 4700
Telefax: 056-211-0200
www.sorsu.edu.ph

ADMISSION TEST PERMIT


Tertiary Level

Period: First
_________________________
Semester A.Y. 2023-2024 Recent 2" x 2" colored ID picture
with white background

Applicant's Name: HISARZA


_________________________________________________________________
JAIRU HAJA None
Last Name First Name Middle Name Name Ext.
Address: ________________________________________________________________________
BURGOS, Casiguran, Sorsogon

Preferred SSC Campus:[X] Sorsogon City [ ] Bulan [ ] Magallanes [ ] Castilla

Course Choices: ____________________/______________________/_______________________


BSED - MATH BTVTED - AUTO _____________________________
1st Choice 2nd Choice 3rd Choice Applicant's Signature

Application Number: ____________________________


ADS23-173911 TEST SCHEDULE
Feb 11, 2023 1:00 PM SorSU Sor. City Tech Bldg. Rm 108
Date of Application: ____________________________
Jan 24, 2023 6:24 PM
Date & Time Venue Seat #
Examinee Number: ____________________________
SC23-106725 Reminders:
• Be at the testing center at least 15 minutes before the time.
Official Receipt: _________________Date: __________
• Bring this Test Permit, rubber eraser, pencils (Mongol #2), sharpener and ballpen.
• Cheating, impersonation and other forms of examination irregularity can be a
Registered by: ________________________________
ANNEBEL C. HERNANDEZ ground for disqualification for admission or dismissal, if admitted.

FM-ADS-002A

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