Republic of the Philippines

PhilSCA ADM Form No. 1

PHILIPPINE STATE COLLEGE OF AERONAUTICS Series No. 1 17-02-V
Piccio Garden, Villamor, Pasay City
PHILSCA ADMISSION TEST APPLICATION FORM
1X1

Important Reminders
1. Accomplish this Form correctly and legibly (Pls. PRINT) Latest
2. Submit this form together with the other requirements and one (1) pc 1x1 latest picture Picture
3. In compliance with Article V Section 35.K of PhilSCA Student Manual applicants
with visible tattoos in the arms, neck, face, hands and legs will not be accepted.

Applicant No.:____________________________
2425A35426 Date of Application:________________
December 18, 2023
Please Check

Freshmen Transferee Second Course Post Graduate Studies Date of Exam: _______________ O.R. # ______________

Bachelor of Science in Aviation Information Technology

Application for: _________ Sem.SY _________
- Course:_________________________________________________________

Last Name: CACAS Date of Birth: March 02, 2006 Nationality: Filipino
First Name: ROMAR JEAN Place of Birth: Flores, San Manuel, Pangasinan
Gender: Male
Middle Name: DELA PEÑA Middle Initial: D Age: 17 Civil Status: Single Contact No.: 09937737936
Address: #141 Zone 4, Brgy. Flores San Manuel Pangasinan Region 1- Religion: Roman Catholic Email Addr.: floresissslgcacas@g
Ilocos Region 2438 mail.com
Father's/Guardian Name: ROMUALDO MADRIAGA CACAS Occupation: DECEASED Contact No.: NONE

Mother's/Guardian Name: MARJORIE DELA PEÑA CACAS Occupation: BARANGAY KAGAWAD / STORE
Contact
OWNER
No.: 09431344753
School Last Attended: School Year: July 11, 2023 GWA:
Submitted Document: (Certified Photocopy only)
Please Check: High School Card Copy of Grade Transcript of Records Certificate of Good Moral Character
I hereby certify that the above information is true and correct.
_______________________
Applicant's Signature