BARILI CAMPUS

Cagay, Barili, Cebu, Philippines

Website: E-mail: Phone: (032) 406 6201

OFFICE OF THE REGISTRAR

RO Form 2
REGISTRATION FORM October 22, 2012
Revision: 2

STUDENT PERSONAL DATA: Date:

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

Home Address:
Congressional District: City Address: Telephone no.
Gender: [ ]Male [ ]Female Birthday: (dd/mm/yyyy) Birthplace: Age:
Citizenship: Religion: Civil Status: [ ]Single [ ]Married [ ]Separated [ ]Widower
Father's Name: Occupation:
Mother's Name: Occupation:
Guardian's Name: Contact Number:
Educational Background Name of School Academic Year Honors Received
Elementary
High School
College
Enrolment Documents Submitted:
[ ] Form 138 [ ] Birth Certificate [ ] Certificate of Good Moral Character [ ] Certificate of Transfer Credentials & TOR [ ] Medical Certificate

“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 College.”

Student’s Signature over Printed Name

STUDENT LOAD
ID Number: Course: Major: Year Level:
School Year: Semester: [ ]1st [ ] 2nd [ ] Summer Enrolment Status: [ ] Regular [ ] Irregular
Student Status: [ ] New [ ] Old [ ] Transferee [ ] Returnee [ ] Shiftee [ ] Cross Enrollee BLOCK SECTION:
MIS Code Course Code Descriptive Title Time Days Room Units
ONLY IRREGULAR STUDENTS WILL WRITE THEIR ENROLLED SUBJECTS AND 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 Schedule & Assessment (Payment of School Fees)
of Student Load)

School Physician/ Nurse System’s Operator Teller

NSTP PTA OFFICE REGISTRAR’S OFFICE

(Enlistment for those who will be taking (Payment for membership/special (Printing of Certificate of Registration
CWTS or ROTC) project/group accident insurance) Submission of registration form/
enrolment credentials)
OR#:
Date:
Coordinator Signature: University Registrar