3/10/23, 1:18 PM DOORSTEP 3/10/23, 1:18 PM DOORSTEP

            I hereby certify that all statements above are true and correct to the best of my knowledge.
Furthermore, I hereby agree and consent that the Office of Admission, Scholarships, and Placement
Republic of the Philippines (OASP) may process, collect and use my personal information for CMUCAT Application and for [  ] APPROVED [  ] DISAPPROVED [  ] PENDING
CENTRAL MINDANAO UNIVERSITY Releasing of my Examination result. I have understood that the information I provide will be disclosed
to CHED, UNIFAST, and other government agencies for scholarships, grants, accreditation, billings, and
OFFICE OF ADMISSIONS, SCHOLARSHIPS AND PLACEMENT for the Potential Funding Agency.
University Town, Musuan, Maramag, Bukidnon             By signing below, I represent and warrant that I am the data subject and that I have read and
understood the Privacy Notice and all of the above provisions.
E-mail: oasp@cmu.edu.ph
_________________________________
JAN BRYLLE EREXIMA Date: _________ CMUCAT BOARD
APPLICATION FORM Signature Over Printed Name Date: ___________
CENTRAL MINDANAO UNIVERSITY COLLEGE ADMISSION TEST (CMUCAT)
Testing Fee: Php 200.00 for 2nd courser (Pay at the CMU Cashier's Office) NOTE: Subject to revocation if the records upon which the approval is based are found incorrect/invalid
----------------------------------- ----------------------------------- -----------------------------------
O.R. NO. __________ ROOM NO.    1   
CENTRAL MINDANAO UNIVERSITY COLLEGE ADMISSION TEST (CMUCAT) PERMIT
A. APPLICANT SEX: MALE O.R. No.: __________________________ Application ID. : CMUCAT-
Application ID.
1X1 20221208NHneQ6B6Wy
CMUCAT- NAME OF EXAMINEE: JAN BRYLLE EREXIMA
Name: EREXIMA JAN BRYLLE ALCAYDE Recent Photo
(Family Name) (First Name) (Middle Name) 20221208NHneQ6B6Wy DATE OF TEST: 2023-03-26 TIME. : 7:30AM
ROOM NO.:    1    LRN: 405054150171
BIRTHDATE: 2004-11-25 AGE: 18
PLACE OF TEST: College of Education
BIRTH PLACE: VALENCIA CITY
HOME ADDRESS P-9 DABONG-DABONG , MAILAG, VALENCIA CITY, BUKIDNON 1X1
__________________________
EMAIL: ereximaj@gmail.com Recent Photo CMUCAT BOARD
RELIGION: ROMAN CATHOLIC ZIP CODE: 8709 __________________________
SCHOOL NAME : PARAMOUNT SCHOOL OF ARTS LANGUAGES MANAGEMENT MOBILE 09687169171 Signature: Date Filed : 2022-12-08
AND SCIENCES INC. NO.: Note: 1. Present this permit to the PROCTOR during the exam. 2. No CMUCAT permit, No Exam.
SCHOOL P-3 BAGONTAAS LRN : 405054150171 (REPRODUCTION OF THIS FORM IS ALLOWED BUT NOT FOR SALE)
ADDRESS :
  B. FAMILY   FATHER   MOTHER CMU-F-1-ASP-003 14 SEPTEMBER 2020 REV. 0 Page 1 of 1
  FULL NAME   JOHN GEQUILLANA EREXIMA   MONNA LOU ALCAYDE EREXIMA
  EDUCATIONAL ATTAINMENT   4TH YEAR HIGHSCHOOL   4TH YEAR COLLEGE
  OCCUPATION   DRIVER   RESCUER
  ANNUAL GROSS INCOME (In pesos)   25000   45000
 C. EDUCATION
  LEVEL   NAME OF SCHOOL   YEAR GRADUATED   HONORS/AWARDS
 ELEMENTARY   EMEU GMA   2017-03-21   WITH HONORS
 HIGHSCHOOL   PARAMOUNT SCHOOL OF   2020-06-19   WITH HONORS
ARTS LANGUAGES
MANAGEMENT AND SCIENCES
INC.
 OTHERS (If Transferee)      
 D. COURSE/S YOU INTEND TO TAKE AT CMU  E. SENIOR HIGH SCHOOL GRADE
    CHOSEN COURSE/S   ENGLISH   89
  FIRST CHOICE   BACHELOR OF SCIENCE IN   MATH   93
MATHEMATICS
  SECOND CHOICE   BACHELOR OF SCIENCE IN   SCIENCE   87
CIVIL ENGINEERING
 F. CERTIFICATION (PRINCIPAL OR SCHOOL DIRECTOR/GUIDANCE COUNSELOR)
       I hereby certify that the applicant is [  ] a Senior High School graduate [  ] a graduating Senior High School student of PARAMOUNT
SCHOOL OF ARTS LANGUAGES MANAGEMENT AND SCIENCES INC. SY:______________

_________________________________ Date:_________________________________
Signature Over Printed Name Designation:_________________________________

 G. APPLICANT'S SIGNATURE  H. ACTION TAKEN (to be filled up by the CMUCAT Board)

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