(Campus-College)

PRELIMINARY REGISTRATION
Please fill out the form completely. Do not leave any blank. SEMESTER: [ ]1ST[ ] 2ND[ ] Summer
SCHOOL YEAR: _______-_______
NAME (Please Print) GENDER CONTACT
NUMBER
EMAIL
Surname Given name Middle name ADDRESS Student No.
COURSE YEAR SECTION SCHOLARSHIP PREFERRED ONLINE
MODE OF MODULAR
INSTRUCTION
STATUS: [ ] New [ ] Old [ ] Transferee [ ] Returnee [ ] Shifter NSTP:[ ]YES[ ]NO
Code Course No Subject Description Units

APPROVE CONFIRME
TOTAL UNITS: D D

PRINTED NAME AND SIGNATURE ADVISER/PROGRAM UNIVERSITY

HEAD REGISTRAR
ESSU-ACAD-203a| Version 5 Page 1 of 1
Effectivity Date: June 10, 2021

(Campus-College)
PRELIMINARY REGISTRATION
Please fill out the form completely. Do not leave any blank. SEMESTER: [ ]1ST [ ] 2ND [ ] Summer
SCHOOL YEAR: _____-_____
--
NAME (Please Print) GENDER CONTACT
NUMBER
EMAIL
Surname Given name Middle name ADDRESS Student No.
COURSE YEAR SECTION SCHOLARSHIP PREFERRED ONLINE
MODE OF MODULAR
INSTRUCTION
STATUS: [ ] New [ ] Old [ ] Transferee [ ] Returnee [ ] Shifter NSTP:[ ]YES[ ] NO
Code Course No Subject Description Units

APPROVE CONFIRME
TOTAL UNITS: D D

PRINTED NAME AND SIGNATURE ADVISER/PROGRAM UNIVERSITY

HEAD REGISTRAR
ESSU-ACAD-203a| Version 5 Page 1 of 1
Effectivity Date: June 10, 2021