Republic of the Philippines

Laguna State Polytechnic University

Province of Laguna

APPLICATION FOR COLLEGE ENTRANCE TEST

Instructions: READ ADMISSION AND APPLICATION REQUIREMENTS AT THE BACK PAGE

Fill in all the required information. DO NOT leave an item blank. if item is not applicable, indicate "N/A".

STATUS OF APPLICANT

Freshmen Transferee Returnee p Shifter g Continuer

PERSONAL INFORMATION
Name Gojas JohA+ Ivan Fidelis F
AGE DATE OF BIRTH SEX CIVIL STATUS CITIZENSHIP
18 2005-10-15 Male Female Single Filipino

COMPLETE PERMANENT MAILING ADDRESS

(HOUSE NUMBER) | (Street/Subdivision) | (Barangay)

01 Purok 2 )Anibong Pagsanjan Laguna 4008

MOBILE NUMBER TRACK/STRAND INTENDED First Choice: Bachelor of EMAIL ADDRESS

COURSE Science in Criminology

09061535831 Second Choice: Bachelor of gojasivan A

outlook.ph Science in Criminology
EDUCATIONAL ATTAINMENT
NAME OF SCHOOL SCHOOL ADDRESS TYPE OF SCHOOL YEAR ATTENDED
ELEMENTARY: Anibong Pagsanjan Laguna Public Private 2011
Anibong Elementary School
HIGHSCHOOL: Poblacion Dos Pagsanjan Public Private 2016
Pagsanjan Integrated National Laguna e
High School
SENIOR HIGH SCHOOL: Pagsanjan Laguna Public Private 2020
Avm Foundation
COLLEGE: (For Transferee) Public From:
To:
Private

Course REASON FOR TRANSFERRING:

RAW SCORE: GWA: GUIDANCE COUNSELOR/GUIDANCE PERSONNEL: DATE FILED:
February 28, 2024
LRN: 108378100013 SIGNATURE OF THE APPLICANT:

Application Number: 154454 LSPU ENTRANCE TEST PERMIT

To be filled-out by applicant
Applicant's Name: JohA+ Ivan Fidelis Gojas
Intended Course: Bachelor of Science in Criminology
SCHEDULE OF EXAMINATION

Date: Approved:
Time:
Room No: Examiner's/Proctor's Signature