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Republic of the Philippines

Mindanao State University


Fatima, General Santos City
OFFICE OF ADMISSIONS

APPLICATION FOR ADMISSION


(OFAD Form No. 1, s.2018)

INSTRUCTION: Print all entries clearly and legibly.


Name: PELAYRE, JARVEE LAHOY LAHOY
(Family Name) (First Name) (Middle Name)
Date of Birth: April 26, 2005 Sex: Male Civil Status: Citizenship:
Religion: Roman Catholic Tribe: Place of Birth: Email:
Present Address: ,
Home Address: , Mobile number: 9635954215
Last School Attended: General Santos City National High School
Father's Name: Tribe: Occupation: Annual Income:
Mother's Name: Tribe: Occupation: Annual Income:
Address: ,
MSU SASE Result: AP: 9 LU: 40 MA: 9 SC: 12 GR: 70 Strand: GAS Date Taken:
Person to be notified in case of emergency:
(Name)
Mother , , ,
(Relationship) (Contact Number) (Address)

(Student's Signature)

(TO BE FILLED UP BY THE ADMISSION OFFICE PERSONNEL)


Admitted as: FRESHMEN ( ) TRANSFEREE ( ) SECOND DEGREE ( ) UNITING ( ) RETURNEE ( )
SEMESTER AND ACADEMIC YEAR ADMITTED: First semester, Academic Year: 2023 - 2024
Admitted in: Diploma in Fish Tech - Aquaculture COLLEGE OF FISHERIES - AQUACULTURE DEPARTMENT
(Course/Major) (College)
Academic Status upon Admission:
Credentials submitted:
MSU SASE/CET Result Photocopy of Birth Certificate (PSA Copy)
Form 138/HS Card OMA Certification (if Muslim)
Good Moral Certificate NCIP Certification (if Tribal)
Transcript of Record Employee Dependent Certification
Honorable Dismissal

Documents Complete Not Complete Checked By: Infirmary:


_____________ _____________
RECOMMENDED BY:
REMARKS: Guidance Office:
(Academic Adviser, Print Name & Sign)

Approved BY: PROF. JERRY J. DELA CRUZ Date:

STUDENT'S PLEDGE

In consideration of my admission to the MINDANAO STATE UNIVERSITY and of the privileges of the student of this institution, I hereby promise
and pledge to abide by and comply with all rules and regulation laid down by competent authority in the University in which I am enrolled.

(Student's Signature)
Date of Enrollment:
Mindanao State University
Guidance Office
GUIDANCE INFORMATION SHEET
First semester, Academic Year 2023 - 2024

Name: PELAYRE, JARVEE LAHOY LAHOY Course & Major: Diploma in Fish Tech - Aquaculture SASE Score: 70
BirthDate: April 26, 2005 Sex: Male Age: 18 Religion: Roman CatholicTribe:
Civil Status: Contact number: 9635954215
Home Address: , Present Address: ,
Honors received:_______________________ Scholarship:____________________ Other Scholarship:______________
School Last Attended: General Santos City National High SchoolDate of Graduation:__________________________
Course choice: Diploma in Fish Tech - Aquaculture (1st choice) (2nd choice) Bachelor of Arts in Islamic Studies Major in Shariah
Family Background:

Name Age Tribe Educational attainment Occupation


Father:
Mother:
Number of Brothers:
Number of Sisters:

Are your parents living together? Yes No. if no, why?___________________________

How much is your family monthly income? Kindly check the box on the left:
Below P1,000 P3,000 - P5,000 P7,000 - P9,000 P11,000 - P13,000
P1,001 - P3,000 P5,001 - P7,000 P9,001 - P11,000 P13,001 - P15,000
Above P15,001

What are your skills?______________________________________________________________________________________

Signature______________________________ Verified by:______________________________

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