Republic of the Philippines Republic of the Philippines

Cagayan State University Cagayan State University

CARIG CAMPUS CARIG CAMPUS
OFFICE OF THE CAMPUS REGISTRAR OFFICE OF THE CAMPUS REGISTRAR
Carig Sur, Tuguegarao City 2X2 ID PHOTO Carig Sur, Tuguegarao City 2X2 ID PHOTO
Reg 25160: Form No. 8 Reg 25160: Form No. 8
STUDENT PROFILE Date:
STUDENT PROFILE Date:
PERSONAL DATA PERSONAL DATA
Last Name Birthdate Last Name Birthdate
First Name Birthplace First Name Birthplace
MidName Age MidName Age
Sex(M/F) Civil Status Sex(M/F) Civil Status
Contact No. Nationality Contact No. Nationality
Email Religion Email Religion
Barangay Province Barangay Province
Permanent Permanent
Address Town/City Zip Code Address Town/City Zip Code
Course First Choice Course First Choice
Preferences Preferences
(based on CSU-CAT) Second Choice (based on CSU-CAT) Second Choice
EDUCATION DATA EDUCATION DATA
Elementary Elementary
Secondary & Secondary &
Address Address
Senior Track Grade 12 GWA Senior Track Grade 12 GWA
For TRANSFEREES School and For TRANSFEREES School and Course
ONLY Course ONLY
Course Course
For SECOND For SECOND
COURSERS only School & Address COURSERS only School & Address

FAMILY DATA FAMILY DATA

Last Name Last Name Last Name Last Name
Mother’s Mother’s
Father’s Father’s First Name First Name
First Name Maiden First Name Maiden
Name Name
Name Middle Name Name Middle Name
Middle Name Middle Name
Monthly Income Monthly Income

I agree and consent that Cagayan State University may use, share and process my personal I agree and consent that Cagayan State University may use, share and process my personal
data for any academic related activities; that the use of which shall be governed by the Data data for any academic related activities; that the use of which shall be governed by the Data
Privacy Act of 2012. Privacy Act of 2012.

_____________________________________________ _____________________________________________
Signature over Printed Name of Student Signature over Printed Name of Student