2/3/2020 DOORSTEP

Republic of the Philippines

CENTRAL MINDANAO UNIVERSITY
University Town, Musuan, Maramag, Bukidnon

OFFICE OF ADMISSIONS, SCHOLARSHIPS AND PLACEMENT

APPLICATION FORM
SENIOR HIGH SCHOOL ADMISSION TEST (SHSAT)

Testing Fee: Php 200.00 for 2nd courser (Pay at the CMU Cashier's Application No: SHSAT-20200203cDvLFqhrLR
Office)

O.R. NO. __________ ROOM NO.    1   

A. APPLICANT SEX: MALE AGE: 16

Name: CORPUZ NON CEDRIC JOHN VEGA

1X1
(Family Name) (First Name) (Middle Name)
Recent Photo
BIRTHDATE: 2003-06-24 CITIZENSHIP: FILIPINO
BIRTH PLACE: VELENCIA BUKIDNON RELIGION: CATHOLIC
HOME P-7 HALAPITAN SAN FERNANDO BUKIDNON , HALAPITAN POB., ZIP CODE: 8711
ADDRESS SAN FERNANDO, BUKIDNON
SCHOOL HALAPITAN NATIONAL HIGH SCHOOL MOBILE NO.: 09067149978
NAME :
SCHOOL HALAPITAN SAN FERNANDO BUKIDNON LRN : 126753090047
ADDRESS :
 B. TRACK AND STRAND OF YOUR CHOICE
  Track 1st choice:   ACADEMIC   Strand 1st choice:   SCIENCE, TECHNOLOGY,
ENGINEERING AND
MATHEMATICS - STEM
  Track 2nd choice:   ACADEMIC   Strand 2nd choice:   GENERAL ACADEMIC STRAND -
GAS
  C. FAMILY   FATHER   MOTHER
  FULL NAME   VERNIE SAREN CORPUZ   DECEASED
  EDUCATIONAL ATTAINMENT   BACHELORS DEGREE   DECEASED
  OCCUPATION   POLICE OFFICER   DECEASED
 D. CERTIFICATION (PRINCIPAL OR SCHOOL DIRECTOR/GUIDANCE COUNSELOR)
       I hereby certify that the applicant is [  ] a Junior High School graduate [  ] a candidate for Junior High School completion of HALAPITAN
NATIONAL HIGH SCHOOL SY:______________

_________________________________ Date:_________________________________
Signature Over Printed Name Designation:_________________________________

 E. APPLICANT'S SIGNATURE  F. ACTION TAKEN (to be filled up by the CMUCAT Board)
       I hereby certify that all information above are true and correct to the
best of my knowledge. Furthermore, I hereby agree and consent that the [  ] APPROVED [  ] DISAPPROVED [  ] PENDING
Office of Admissions, Scholarships, and Placement (OASP) may utilize my
information in posting of the result and billing purposes.

Date: _________
CEDRIC JOHN CORPUZ NON _________________________________
Signature Over Printed Name CMUCAT BOARD
Date: ___________

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

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2/3/2020 DOORSTEP
SENIOR HIGH SCHOOL ADMISSION TEST (SHSAT) PERMIT
O.R. No.: __________________________ Application ID. : SHSAT-20200203cDvLFqhrLR
1X1 NAME OF EXAMINEE: CEDRIC JOHN CORPUZ NON
Recent Photo DATE OF TEST: 2020-03-01 TIME. : 9:00 AM
ROOM NO.:    1    LRN: 126753090047
PLACE OF TEST: CMU-College of Education

__________________________
CMUCAT BOARD
__________________________
Signature: Date Filed : 2020-02-03
Note: 1. Present this permit to the PROCTOR during the exam. 2. No SHSAT permit, No Exam.
(REPRODUCTION OF THIS FORM IS ALLOWED BUT NOT FOR SALE)

CMU-F-1-ASP-003 03 JUNE 2019 REV. 0 Page 1 of 1

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