CPU Reg Form 49 Rev 2 (March 11, 2019)

CENTRAL PHILIPPINE UNIVERSITY

loilo City, Philippines
COLLEGIATE APPLICATION FOR GRADUATION
Instructions:
Fill out two (2) copies of the application form clearly in print. (one for the
Registrar, one for the Dean).
Indicate all necessary information.
Cross-enrolment should be indicated in the subject assignments. If currently with
cross-enrolment, a certificate of enrolment from
said school should be attached to the Registrar's Copy. Likewise, a certification
of grades from previous cross-enrolment should
be attached.
Notify in writing the Registrar through the Dean if changes in subject
assignments after application has been filed. This should
be done not later than two (2) days after the change. Attach a photocopy of your
New Enrolment Record and approved overload letter
when necessary
ID Number: 18-3825-31
PERSONAL RECORDS
NAME
Castro
Therelean
Ferraris
SEX
F
CITIZENSHIP Filipino
Family Name
First Name
Middle Name
DATE OF BIRTH
June 4, 1996
PLACE OF BIRTH (TOWN)
Kabankalan City
PARENT: Father's Name
Alfredo Uycoque Castro
Mother's Maiden Name
Eleanor Franco Ferraris
PERMANENT ADDRESS Teacher's Village, Brgy. 1, Kabankalan City, Negros
Occidental, 6111
PRESENT ADDRESS Wisdom sea dormitory, San Jose St., Jaro, Iloilo City, Iloilo
CELLPHONE NO. 09052827605 LANDLINE NO.
EMAIL ADDRESs rmthereleancastro@gmail.com
PRELIMINARY EDUCATION
SCHOOL
KINDERGARTEN
Esteban R. Abada Memorial School - West
ELEMENTARY
Fellowship Baptist College
HIGH SCHOOL
COLLEGIATE
Southland College
Colegio San Agustin - Bacolod - BS in Medical Technology
SCHOOL YEAR GRADUATED
2002-2003
2008-2009
2012-2013
2016-2017
DEGREE/TITLE _
CPU - Doctor of Medicine
MAJOR
Check I if candidate for LOYALTY AWARD (have not transferred/attended any
school since Kinder to College/
Elementary to Post Graduate except CPU)
SUBJECTS ASSIGNED ON TERM GRADUATING
2nd Semester
Semester / Summer
2021-2022
School Year
COURSE NO.
1. CAnes 824
DESCRIPTIVE TITLE
- Clinical Clerkship in Anesthesiology
2. CENT 823
Clinical Clerkship in EENT
3.
CMed 818
Clinical Clerkship in Medicine
CNeuro 825
Clinical Clerkship in Neuropsychiatry
5.
COBGyn 822
Clinical Clerkship in Obstetrics and Gynecology
6.
CPed 819
Clinical Clerkship in Pediatrics
7.
CPFM 820
Clinical Clerkship in Community/ Family Medicine
CRadio 826
Clinical Clerkship in Radiology
Surge 821
Clinical Clerkship in Surgery and Orthopedics
CCompre 827
Comprehensive Examination and Review
CREDITS
2 weeks
2 weeks
8 weeks
2 weeks
8 weeks
8 weeks
8 weeks
2 weeks
8 weeks
0.16 weeks
This is to certify that all information stated above are true and correct based on
authentic recor
January 29, 2022
Date
Student's Signature
The above subject assignments and information are verified and certified correct;
the application for graduation is
forwarded to the Registrar for processing.
Chairman's Signature over Printed Name/Date
Dean's Signature over Printed Name/Date