Application No: 2023-A-41389 Application Date: Mar 14 2023
Approved
Marikina Resident Non-Marikina Resident
Residency:
Applying for: Undergraduate Program New Freshmen
Desired Program/s
First Choice: BSCR Major: (if any) NONE
Second Choice: Major: (if any)
Campanero Steven John Jacinto
Name
Last Name First Name Middle Name
Portobello, Bankers village,
St. anthony, Block 3 Lot 24 San Mateo
Guitnang Bayan 1
Present Address
House/Block/Lot No.
Barangay City/Municipality
Street/Subdivision/Village
Contact No: 09611520843 Email: steven.campanero@gmail.com Gender: Male
San Juan City, Metro
Age: 18 Birth Date: 2/16/2005 Birth Place:
Manila
With
Civil Status: Single Nationality: Filipino No
Disability:
Father's Name: Campanero, Jason, Barte Occupation: GRab Driver
Mother's Name: Campanero, Jo-ann, Jacinto Occupation: Housewife
Guardian's
Campanero, Jo-ann, Jacinto Occupation: Housewife
Name:
Number of Working
2 Monthly Income of Family: 10000.00 No
Sibling/s: Student:
EDUCATIONAL BACKGROUND
School Name Guitnang Bayan 1 Elementary School
ELEMENTARY School Address Guitnang Bayan 1, San Mateo, Rizal
Year Graduated 2018
School Name (Junior High) Nuestra Señora De Aranzazu Parochial School
School Address General Luna Street, Barangay Guitnangbayan 1, San Mateo,Rizal
Year Graduated 2021
SECONDARY
School Name (Senior High) Pamantasan ng Lungsod ng Marikina
School Address Rainbow Street, SSS Village, Marikina
Track/Strand Academic Science, Technology, Engineering, Math (STEM)
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)
Photocopy of any valid Primary Government Issued ID of student/parent
For Marikina Residents
(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 at the end of Academic Certificate of Enrollment
Year 2022-2023
Photocopy of Form 138 (Senior High School Report Card Grade 12)
Grade 12 student who graduated
prior to Academic Year 2022-2023 Certificate of Non-issuance of Numerical Grades (Issued by the School Registrar - for Applicants from
schools with non-numerical (Pass/Fail) grades)
Certificate of Rating for Passer of the Philippine Educational Placement Test (PEPT), Alternative
For ALS Passer 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
For Transferees
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
