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Certificate No. AJA19-0226

UNIVERSITY ADMISSION APPLICATION FORM*

SCHOOL YEAR CAMPUS APP_REF NO.

DEGREE PROGRAM CHOICES

BUSINESS ACCOUNTAN
BS TOURISM MANAGEMENT CY
FIRST CHOICE SECOND CHOICE THIRD CHOICE

APPLICANT NAME (Please Print) EMAIL

jingty
@gm
ail.co
ADDRESS m
TY JIMROSE JASOJASO
CONTACT 09518156583
NUMBER
FAMILY NAME FIRST NAME MIDDLE NAME

FEMALE SINGLE
DATE OF BIRTH (mm/dd/yyyy) PLACE OF BIRTH (Town, Province) GENDER CIVIL STATUS
PERMANENT ADDRESS
BORONGANCIT EASTERN
CAMPESAO Y SAMAR
BARANGAY MUNICIPALITY PROVINCE
LAST SCHOOL ATTENDED
EASTERN SAMAR BRGY. ALANG
NATIONAL ALANG ACCOUNTANCY
COMPREHENSIVE HIGH BORONGAN & BUSINESS
SCHOOL CITY MANAGEMENT 2019-2020
NAME OF SCHOOL ADDRESS ACADEMIC TRACK YEAR

DECLARATION
Do you have a physical condition which may affect your performance in College? ___ Yes _√__ No
If yes, please state the physical condition.

Have you been subjected to any disciplinary action? ___ Yes _√__ No
If yes, please state the disciplinary action.

The information on this form will be used in accordance with the University’s policy on personal data. I certify
that the information above is true, complete and correct. I understand that falsification or withholding of
information on this form will nullify my application and/or subject me to dismissal from the University
SIGNATURE OVER PRINTED NAME DATE
*Please attach a copy of your Form 138 upon submission.
When complete please submit/email to:
The University Registrar
registrar@essu.edu.ph

ESSU-ACAD-100.a| Version 1
Effectivity Date: April 20, 2020