Republic of the Philippines

ISABELA STATE UNIVERSITY

Ilagan City, Isabela

OFFICE OF THE REGISTRAR 2X2 ID

picture with white
ADMISSION FORM background and
name tag
/ FRESHMAN READMISSION FOREIGN STUDENT
TRANSFEREE SECOND COURSE
CPE STUDENT CROSS-ENROLLEE CLEMENTE O. TAMANG JR.
PLEASE PRINT ALL ANSWERS STUDENT ID NO. 103893070034
LAST NAME/SURENAME: FIRST NAME/GIVEN NAME: MIDDLE NAME:

Tamang Clemente, Jr. Ortiz

PERMANENT HOME ADDRESS: DIALECT SPOKEN:

Caligayan Tumauini, Isabela Ilokano, Ybanag, Tagalog

BIRTHDAY: BIRTHPLACE: AGE: RELIGION

November 15, 2001 Caligayan Tumauini, Isabela 18 Catholic

SEX: CITIZENSHIP: CIVIL STATUS: CP NUMBER: 09970686537
Male Filipino Single EMAIL ADDRESS: Tamangclem95@gmail.com
FATHERS NAME: OCCUPATION:
Clemente Z. Tamang Sr. Farmer
MOTHERS NAME: OCCUPATION:
Merly O. Tamang Farmer
ADDRESS: CP NUMBER:
Caligayan Tumauini, Isabela +639559422897
GUARDIANS NAME: Address: CP NUMBER:

BOARDING HOUSE ADDRESS:

INCLUSIVE DATES OF DEGREE/

SCHOOLS ATTENDED ADDRESS HONORS RECEIVED IF ANY
ATTENDANCE UNITS
ELEMENTARY Caligayan Elementary Caligayan Tumauini, 2008-2014 With Honors
School Isabela
JUNIOR HIGH SCHOOL Antagan National High Antagan 1st Tumauini, 2014-2018
School Isabela
SENIOR HIGH SCHOOL Antagan National High Antagan 1st Tumauini, 2018-2020
School Isabela
VOCATIONAL
COLLEGE

Have you ever been subjected to academic or disciplinary action (probation, suspension, dismissal) from any school
attended? ( ) YES ( / ) NO
I HEREBY CERTIFY that all answers given above are true and correct to the best of my knowledge and belief, I
understand that giving false information will disqualify me for admission or subject me to dismissal after admission has been
granted. I agree to abide by the rules and regulations of Isabela State University.

September 11, 2020 Clemente O. Tamang Jr.

Date Name and Signature of Applicant

ADMISSION FOR: ( / ) FIRST SEMESTER ( ) SECOND SEMESTER ( ) SUMMER SCHOOL YEAR, 20_20_____ - 20 __21___
DO NOT FILL UP BELOW THIS LINE.
SCORE COLLEGE: RESULTS:
EQUIVALENT INTERVIEW RATING:
REMARKS INTERVIEWED BY: REMARKS

ISUI–Reg–Afo–056
Effectivity: April 04, 2018
Revision: 0
 RELEASED BY: DATE OF INTERVIEW: EXAMINED BY:
DATE OF RELEASE: DATE:
COURSE TO ENROLL: DATE:

APPROVED FOR ENROLLEMENT:

(Testing and Admission Unit Representative)
FOR ADMISSION OFFICER/REGISTRAR (Submitted the following credentials)
CAT Results NCAE Honorable Dismissal ACR/Study Permit
Form 138 GMRC NSO Birth Certificate NO Requirements
Form 137 TOR Marriage Cert (form married Woman

Note: Students who have attended other schools/colleges beyond high school muct request Official Transcript of Records with statement of Honorable Dismissal to be sent to the
College/Dean/Registrar, Isabela State University City of Ilagan Campus, City of Ilagan 3300 Isabela. This application will not be considered until these have been received.

ISUI–Reg–Afo–056
Effectivity: April 04, 2018
Revision: 0