Generated: November 6, 2023 - 06:27:28 pm

Submission Schedule - January 8, 2024 AM

Admission Information - 011834- 1st semester 2024-2025
Campus - CvSU-Main
Entry: New Type: Grade 12 student Applicant Type: Filipino
Strand: STEM
LRN: 108734110013
Preferred Course:
BSCPE

Personal Information
Name: GAYETA, MA. PAULINE MAE ROSY Sex: Female
Address: Pasinaya West,Timalan Balsahan,Naic,CAVITE,4110
Email: mapaulinegayeta@gmail.com Mobile#: 09163095342
Birthdate: 2006-06-21 Nationality: Filipino Civil Status: Single
PWD: No Indigenous: No
Family Background
Contact Occupation
Father: Gerardo Gayeta
Mother: N/A
Guardian: Gerardo Gayeta 09068066344 N/A
Family Income: 21,000-30,000 Number of siblings:1
Educational Background
Elementary
Dungawan Central Elementary School Quezon Province 2017 Public
High School
Amaya School Of Home Industries Sahud-Ulan, Tanza, Elementary 2022 Public
Senior High School
Colegio De Montessori, Inc. Timalan Balsahan, Naic, Cavite 2024 Private
Medical History Information
Medications: To be filled up by the OSAS/Guidance Staff
Medical SUBMITTED REQUIREMENTS
Condition/s: __ Ordinary A4-size folder
I hereby acknowledge that all information stated above is true and New Student (Grade 12 student)
correct as to the best of my knowledge. I am submitting the correct __ Copy of accomplished application form for admission
and true document/s in compliance with the admission policy. Further, __ Photocopy of Grade 11 report card
I give consent for my personal data included in my offer to be __ Certificate from the Principal or Adviser indicating that the applicant
processed for the purposes of admission and enrolment in accordance is currently enrolled as Grade 12 student and the strand is also
with Republic Act 10173 - Data Privacy Act of 2012. indicated
Assessed by:___________________________
Control No.:011834

Signature over printed name

 Instruction on placing the control number stub in the folder CONTROL NO.

1. After you have printed your application form, kindly cut the control number 011834
stub that you see in the right portion of the form.
2. Paste the control number stub on the label corner of A-4 size folder using (cut the stub above)
glue.

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