Republic of the Philippines

CEBU TECHNOLOGICAL UNIVERSITY

Danao Campus
Sabang, Danao City, Cebu 6004, Philippines
website: http://www.ctu.edu.ph E-mail: registrar-danao@ctu.edu.ph
Phone: +6332 354 366 local 108/ +63 917 317 0329
RO Form 2
REGISTRATION FORM October 22, 2012
Revision 2

STUDENT PERSONAL DATA: Date:

AMAT NICOLE ANN CORTES

( Last Name ) ( First Name ) ( Middle Name )

Home Address: PUROK GEMILINA, YATI Telephone No: 9275267348

Congressional District: LILOAN City Address: CEBU E-mail Address: nicoleann.amat@ctu.edu.ph
Gender: [ ]Male [ / ]Female Birthday: (mm/dd/yyyy) 10/12/2003 Birthplace: :BRGY. SABANG, POLILLO, QUEZON
Citizenship: FILIPINO Religion:CATHOLIC Civil Status: [/ ]Single [ ] Married [ ] Separated [ ] Widow/er
Father's Name: ERNIE R. AMAT Occupation: GLASS & ALUMINUM INS.

Mother's Name: MYRNA C. CORTES Occupation: HOUSEWIFE

Guardian's Name: MYRNA C. CORTES Contact Number: 9159405867

Educational Background: Name of School Academic Year Honors Received
Elementary: JOSE PLATON MEMORIAL SCHOOL 5TH HONOR
High School: STA.ANASTACIA-SAN RAFAEL NATIONAL HIGH SCHOOL 2015-2019 ACHIEVER
College:
ENROLLMENT DOCUMENTS SUBMITTED (for NEW and TRANSFEREE student only)
[ ] DepEd Form 138 /Report Card [ ] Birth Certificate from NSO [ ] Certificate of Good Moral
[ ] Certificate of Transfer Credentials & TOR [ ] Marriage Certificate if applicable
" I hereby certify that all entries are true and correct. I do solemnly swear to abide with the laws, policies,
rules and regulations set forth by the University."

Student's Signature over Printed Name

STUDENT LOAD:
ID Number: 3210259 Course: BTLED Major: HE-E Year Level: 1
School Year: 2021-2022 Semester: [ ] 1 [ / ] 2 [ ] Summer Term
st nd
Enrolment Status: [ / ] Regular [ ] Irregular
Student Status: [ ] New [/ ] Old [ ] Transferee [ ] Returnee [ ] Shiftee [ ] Cross Enrollee BLOCK SECTION: BTLED_EVE_1
MIS Code Course Code Descriptive Title Time Days Room Units

EVALUATED BY:
College Dean/ Enrollment Committee: Evaluation date: Total Units:

APPROVED BY:
MEDICAL CLINIC MIS OFFICE CASHIER'S OFFICE
( Physical Examination ) (Encoding of Class Schedules (Payment of School fees)
Assessment of Student Load)

______________________ ______________________ __________________

School Physician/Nurse System's Operator Cashier

NSTP PTA Office REGISTRAR'S OFFICE

( Enlistment for those who will (Payment of membership/special project/group accident insurance) (Submission of registration form and credentials

be taking CWTS OR ROTC) Printing of Certificate of Registration)

_____________________
Coordinator PTA Officer Registrar