Republic of the Philippines

CENTRAL MINDANAO UNIVERSITY

OFFICE OF ADMISSIONS, SCHOLARSHIPS AND PLACEMENT
University Town, Musuan, Maramag, Bukidnon
E-mail: oasp@cmu.edu.ph

APPLICATION FORM
CENTRAL MINDANAO UNIVERSITY COLLEGE ADMISSION TEST (CMUCAT)
Testing Fee: Php 200.00 for 2nd courser (Pay at the CMU Cashier's Office)

O.R. NO. __________ ROOM NO. 1

A. APPLICANT SEX: MALE Application ID.

CMUCAT-20240424JlCCqCNTgR
Name: TORIBIO PATRICK MERENCILLO
(Family Name) (First Name) (Middle Name)
BIRTHDATE: 2005-12-03 AGE: 18
BIRTH PLACE: NAGA CITY
1X1
HOME ADDRESS MIBANTANG QUEZON BUKIDNON , MIBANTANG, QUEZON, BUKIDNON Recent Photo
EMAIL: ehtrickmerencillo@gmail.com
RELIGION: ROMAN CATHOLIC ZIP CODE: 8715
SCHOOL NAME : NATIONAL QUEZON BUKIDNON COMPREHENSIVE HIGHSCHOOL MOBILE NO.: 09927215228
SCHOOL ADDRESS : MIBANDO POBLACION QUEZON BUKIDNON LRN : 127735110069
B. FAMILY FATHER MOTHER
FULL NAME MELENCIO HERNANDEZ TORIBIO ARLYN MERENCILLO TORIBIO
EDUCATIONAL ATTAINMENT HIGHSCHOOL COLLEGE GRADUATE
OCCUPATION SEAMANFISHERMAN HOUSEWIFE
ANNUAL GROSS INCOME (In pesos)
C. EDUCATION
LEVEL NAME OF SCHOOL YEAR GRADUATED HONORS/AWARDS
ELEMENTARY MIBANTANG ELEMENTARY SCHOOL 1970-01-01 WITH HONORS
HIGHSCHOOL QUEZON BUKIDNON COMPREHENSIVE 2024-05-30
NATIONAL HIGH
OTHERS (If Transferee) NA 1970-01-01
D. COURSE/S YOU INTEND TO TAKE AT CMU E. SENIOR HIGH SCHOOL GRADE
CHOSEN COURSE/S ENGLISH 80
FIRST CHOICE BACHELOR OF SCIENCE IN CIVIL MATH 80
ENGINEERING
SECOND CHOICE BACHELOR OF SCIENCE IN SECONDARY SCIENCE 89
EDUCATION MAJOR IN SCIENCES
F. CERTIFICATION (PRINCIPAL OR SCHOOL DIRECTOR/GUIDANCE COUNSELOR)
I hereby certify that the applicant is [ ] a Senior High School graduate [ ] a graduating Senior High School student of NATIONAL QUEZON BUKIDNON
COMPREHENSIVE HIGHSCHOOL SY:______________

_________________________________ Date:_________________________________
Signature Over Printed Name Designation:_________________________________

G. APPLICANT'S SIGNATURE H. ACTION TAKEN (to be filled up by the CMUCAT Board)

I hereby certify that all statements above are true and correct to the best of my knowledge.
Furthermore, I hereby agree and consent that the Office of Admission, Scholarships, and Placement (OASP)
[ ] APPROVED [ ] DISAPPROVED [ ] PENDING
may process, collect and use my personal information for CMUCAT Application and for Releasing of my
Examination result. I have understood that the information I provide will be disclosed to CHED, UNIFAST, and
other government agencies for scholarships, grants, accreditation, billings, and for the Potential Funding
Agency.
By signing below, I represent and warrant that I am the data subject and that I have read and
understood the Privacy Notice and all of the above provisions.
_________________________________
PATRICK TORIBIO Date: _________ CMUCAT BOARD
Signature Over Printed Name Date: ___________

NOTE: Subject to revocation if the records upon which the approval is based are found incorrect/invalid
 ----------------------------------- ----------------------------------- -----------------------------------

CENTRAL MINDANAO UNIVERSITY COLLEGE ADMISSION TEST (CMUCAT) PERMIT

O.R. No.: __________________________ Application ID. : CMUCAT-20240424JlCCqCNTgR
1X1 NAME OF EXAMINEE: PATRICK TORIBIO
Recent Photo DATE OF TEST: 2024-05-05 TIME. : 8:00 AM
ROOM NO.: 1 LRN: 127735110069
PLACE OF TEST: Lapasan National High School

__________________________
CMUCAT BOARD
__________________________
Signature: Date Filed : 2024-04-24
Note: 1. Present this permit to the PROCTOR during the exam. 2. No CMUCAT permit, No Exam.
(REPRODUCTION OF THIS FORM IS ALLOWED BUT NOT FOR SALE)

CMU-F-1-ASP-003 14 SEPTEMBER 2020 REV. 0 Page 1 of 1