DEPARTMENT OF MILITARY SCIENCE AND TACTICS

INITAO COLLEGE ROTC UNIT

1005 (MOR) CDC, 10RCDG, ARESCOM
TH

Jampason, Initao, Misamis Oriental

ROTC REGISTRATION FORM

Student No. ___________________ MS: ________________ Date: ____march 19,2021

Name: _ Ubay-ubay, Kent Paul ___________ Camara
(Last Name) (First Name) (Middle Name)
Temporary Address:
No/St/VII/Brgy: P-6, Quezon St. Poblacio
Municipality: Naawan Misamis Orienta
Telephone/Mobile Number: _09264808653____________________________________
Course: BS-CRIM 1-G5______ School: _Initao College_________ Religion: Roman Catholic___
Date of Birth: August 21, 1992 Place of Birth: Naawan Misamis Oriental___________________
Height 5’4 Weight __75kl Complex: __Brown__ Blood Type: _O+_Gender: Male_________
Permanent Address
No/St/Vill/Brgy: : P-6, Quezon St. Poblacio _____________________________________
Municipality: Naawan______________________________________________________
Province: Misamis Oriental__________________________________________________
Telephone/Mobile Number: 09264808653______________________________________
Father’s Name: Lester D. Ubay-ubay Occupation: Farmers______________
Mother’s Name: Janeth C. Ubay-ubay___________Occupation: Teacher___________________
Person to be notified in case of emergency:
Name: Janeth C. Ubay-ubay __________________ Relationship: Mother__________________
Address: Pob. Naawan Misamis Oriental_________ Contact No: 09355979518

MS SEMESTER SCHOOL YEAR GRADES REMARKS

_______ ___________ ______________ ________ ___________
_______ ___________ ______________ ________ ___________
_______ ___________ ______________ ________ ___________
_______ ___________ ______________ ________ ___________

Are you willing to take Advance Course? [ ] YES [ ] NO

___________________
(Signature of Student)
RENATO A DOROTEO
MAJ (CAV) PA
Commandant
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ -_ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _

The bearer Male/Female cadet _________________________________________________________

has been registered in this department for the ____________ Sem, SY __________ ___________
advance/Basic Male/ Female Cadets and assigned to __________________________________________
Will report on the day of training at 0700H – 1200H at Initao College ROTC UNIT. Failure to attend ROTC
instruction for Three (3) accumulative meetings or equivalent to eighteen (18) hours you will be DROPPED
from the roster to active cadets.

_____________________________
(Signature of Interviewer)