Republic of the Philippines 2X2

Tarlac State University PHOTO (2 PCS.)

REGISTRATION OFFICE COLORED with WHITE
Tarlac City BACKGROUND
with name tag

APPLICATION FOR GRADUATION LASTNAME, FirstName MiddleName

2nd Semester, School Year 2021 - 2022

PLEASE FILL IN ALL ITEMS

A. NAME: Ibuos Joshua Gaspar Student No: 2018102519

Last Name First Name Middle Name Contact No: 09167441526
Complete Address: Purok Quirino, Brgy. San Juan, Moncada, Tarlac Date of Birth: October 20. 1999
Course Applied for: BSEE Major:
Civil Status: Single Gender: Male Age: 23 Height: 165 cm E-mail Add: joshuaibuos131@gmail.com
Name of Parent / Guardian: Iluminada G. Ibuos Religion: Seventh Day Adventist
School Last Attended (High School): Central Institute of Technology School Address: Poblacion Norte, Paniqui, Tarlac
School Last Attended (if transferee): School Address:

B. PRESENT LOAD / SUBJECTS UNITS PRINTED NAME OF INSTRUCTOR SIGNATURE OF INSTRUCTOR

EEP423 POWER SYSTEMS ANALYSIS 3.00 FLORA, CRISPIN I.
EEP421L POWER SYSTEMS ANALYSIS LAB. 1.00 FLORA, CRISPIN I.
EEP441L FUNDAMENTALS OF POWER PLANT ENG’G 1.00 MOHAMMED, MERVIN P.
EEP463 EE ELECTIVE 2 3.00 PIO, LEO P.
EEP482 DISTRIBUTION SYSTEM AND SUBSTATION 2.00 YUMUL, RAFAEL R.
EEP481L DISTRIBUTION SYSTEM AND SUBSTATION LAB. 1.00 YUMUL, RAFAEL R.
EEP461L RESEARCH PROJECT OR CAPSTONE 1.00 DOMINGO, ENALYN T.
EEP401F SEMINARS/COLLOQUIA/ PLANT VISIT 1.00 FLORA, CRISPIN I.
B423 TECHNOPRENEURSHIP 3.00 MARCOS, ROBERT V.
EEP402 EE CORRELATION 2.00 FLORA, CRISPIN I.

Total No. of Units presently enrolled 18.00 Units

I hereby promise in case of approval of my graduation to participate in all
activities and pay the required fees.

IBUOS, JOSHUA G.

Signature over printed name

C. EVALUATION OF RECORDS BY THE DEAN

The Dean or Head check and evaluate the records of the students thru the evaluation form provided by
the Office of the University Registrar and to be resubmitted by the student to the University Registrar with this
application.

APPROVED FOR PREPARATION

APPROVED FOR RECOMMENDATION OF GRADUATION RECORDS

Dr. Miriam S. Galvez

College Dean In-Charge of Records

DATE FILED: 05/10/22

Requirements:
Form 137-A (original copy)
Original Transcript of Records (for transferees) APPROVED:
Certificate of live Birth from PSA (photocopy)
Marriage Certificate from PSA (for married female)
2 pcs. 2x2 Picture (colored w/ complete name) LN, FN MN
2 pcs. Documentary Stamp (BIR) Director
Form No.: TSU-REG-SF-11 Revision No: 01 Effectivity Date: February 19, 2019 Page 1 of 1