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UNIVERSITY OF CALOOCAN CITY

FRESHMEN ADMISSION FORM

APPOINTMENT DETAILS:

FRESHMEN APPOINTMENT CODE : 2023-1-06593

CAMPUS : SOUTH
DATE : Monday, April 24, 2023
TIME : 08:00 AM-10:00 AM

PERSONAL INFORMATION:
NAME: Casin, Carla Alonzo AGE: 18 SEX: Female
LAST NAME FIRST NAME MIDDLE NAME
ADDRESS: San Benissa Garden Villas 11321 Commonwealth Avenue Kaligayahan Qc Metro Manila 1124
BARANGAY NUMBER: Kaligayahan ZONE: 0 DISTRICT: 4
DATE OF BIRTH: June 29, 2004 PLACE OF BIRTH: San Juan Medical Center
CIVIL STATUS: Single CITIZENSHIP: Filipino RELIGION: Catholic
MOTHER'S NAME: Lovelyn Alonzo OCCUPATION: Freelancer
FATHER'S NAME: Adonis Casin OCCUPATION: Health Worker
RESIDENCE TELEPHONE NO.: 0284616551 CELLPHONE NO.: 09273572152
GUARDIAN: Lovelyn Alonzo RELATION: Mother
ADDRESS: Blk 24 Lot 37 Narra St Alecon Homes Brgy Llano 167 Caloocan City
EDUCATIONAL BACKGROUND:
ELEMENTARY: Deparo Elementary YEAR GRADUATED: 2016-06
HIGH SCHOOL: Deparo High YEAR GRADUATED: 2017-06
SENIOR HIGH SCHOOL: Electron College Of Technical Education YEAR GRADUATED: 2023-06
(PLEASE SPECIFY THE STRAND) Tvl Comprog

I, solemnly swear that the information provided in this application are true and correct, the supporting documents are
authentic, and that making false statements, furnishing falsified or forged documents in support thereof are punishable by
law.

SIGNATURE OVER PRINTED NAME

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Documents Submitted: Average : Registrar :
Form 138 Good Moral Voter ID Diploma (HS)
Birth Certificate 2x2 Picture Voter Cert. Diploma (Elem)
Date of Examination: Room No.: Seat: MIS :

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UNIVERSITY OF CALOOCAN CITY

Accounting Office
ORDER OF PAYMENT

DATE: ______________
April 24, 2023
THE CITY TREASURER:

Please accept the payment of Casin, Carla Alonzo

For payment of ENTRANCE EXAM of P100.00

GCASH Number Transaction Number: OR Number:

RYAN N. ALEJO, CPA, DPA

University Accountant