Application No: 2024-A-50437 Application Date: Mar 20 2024

Applying for: Undergraduate Program New Freshmen

Desired Program/s
First Choice: BSBA Major: (if any) FIMA
Second Choice: BSHM Major: (if any) NONE

Fernandez Ann Eunice Acaba

Name
Last Name First Name Middle Name

#4 B Santos st. Sto. Niño Marikina City

Present Address
House/Block/Lot No. Street/Subdivision/Village Barangay City/Municipality

Contact No: 09070172391 Email: anneunicefernandez@gmail.com Gender: Female

Age: 17 Birth Date: 7/18/2006 Birth Place: Malanday Marikina City
Civil Status: Single Nationality: Filipino With Disability: No
Father's Name: Jesus, , Lambino Occupation: Grocery Staff
Mother's Name: Fernandez , Rutchel, Acaba Occupation: house wife
Guardian's Name: -, -, - Occupation: N/A
Number of Sibling/s: 4 Monthly Income of Family: 10000.00 Working Student: No

EDUCATIONAL BACKGROUND
School Name Sto. Niño Elementary School
ELEMENTARY School Address P. Antonio St. Sto Niño Marikina City
Year Graduated 2018
School Name (Junior High) Sto. Niño National High School
School Address Agricultores St. Sto Niño Marikina City
Year Graduated 2022
SECONDARY
School Name (Senior High) Pamantasan ng Lungsod ng Marikina Senior High
School Address Nicanor Roxas St., San Roque , Marikina City
Track/Strand Academic Accountancy, Business, Management (ABM)
General Weighted Average ; Grade 12: 91; Grade 12: 91

School Name
School Address
VOCATIONAL
Degree
Year of Completion
School Name No
School Address
TRANSFEREE
Program
Year Last Attended

Check List of Documents to be Submitted

Two (2) pcs. of recent 2x2 photo (with name tag and in white background, with neutral facial expression, must not be wearing eyeglasses or colored
contact lenses, and with ears exposed if religious customs do not prohibit)

Photocopy of PSA Birth Certificate

Photocopy of Proof of Billing (Meralco, Water, Telephone) under the name of the student or parent
Valid Identification or Proof of Residency Photocopy of any valid Primary Government Issued ID of student/parent
(Voter's ID/Voter's Certification, National ID, Driver's License, UMID ID - SSS/GSIS, Senior Citizen ID, PWD ID)
Grade 12 student expected to graduate Photocopy of Form 138 (Senior High School Report Card Grade 12)
at the end of Academic Year 2023-2024
Certificate of Non-issuance of Numerical Grades (Issued by the School Registrar - for Applicants from schools
with non-numerical (Pass/Fail) grades)
 Good Moral Certificate
Photocopy of Form 138 (Senior High School Report Card Grade 12)
Student who graduated from Grade 12 in Certificate of Non-issuance of Numerical Grades (Issued by the School Registrar - for Applicants from schools
AY 2023-2024 or earlier with non-numerical (Pass/Fail) grades)

Good Moral Certificate

For PEPT, NFE A&E or ALS Passers
For Transferees
Certificate of Rating for Passer of the Philippine Educational Placement Test (PEPT), Alternative Learning
System (ALS), or Non-Formal Education Accreditation and Equivalency (NFE A&E) Program for non-Secondary
graduates only
Photocopy of Transfer Credentials/Honorable Dismissal, Transcript of Record (TOR) and/or Certified True
Copy (CTC) of Grades

For Married Females Photocopy of Marriage Certificate

I hereby certify that above information given are true as to the best of my knowledge.

Applicant's Signature Over Printed

Name