POLYTECHNIC UNIVERSITY OF THE PHILIPPINES

OFFICE OF THE UNIVERSITY REGISTRAR

ADMISSION SERVICES
STA. MESA, MANILA

CAEPUP 2022 APPLICATION FORM

REFERENCE NUMBER: 2023-0057-6225 DATE OF APPLICATION: 12/27/2022
PERSONAL INFORMATION:
Complete Name: Ty, Gian Henry Baliquia
Sex: MALE Height: 173 cm. Date of Birth: 02/24/2005

Civil Status: SINGLE Weight: 60 kg

CONTACT INFORMATION:
Contact Number/s: 09480974098
Email Address: gianhenryty5@gmail.com
Address: 25, Mississippi st., ValleyViewRoyale, Brgy. San Juan, CAINTA, Philippines (the)

IN CASE OF EMERGENCY, Please No fy:

Contact Number/s: 09755262091
Contact Person: Giovanni N. Ty
Address: Near at plaza, Brgy. Alugan, SAN POLICARPO, Philippines (the)

ACADEMIC INFORMATION (LAST SCHOOL ATTENDED):

Mode of Learning: Senior High School LRN 122733100107

School Name: Arellano University, Andres bonifacio Campus

School Address: 239 Pag-asa Street, Pasig, Metro Manila
Year Graduated: 2023

EMPLOYMENT INFORMATION (OPTIONAL):

Company: Not Employed Contact Number/s: Not Applicable

Address: Not Applicable

ACADEMIC PROGRAM PREFERENCES:

1. BSCE-BACHELOR OF SCIENCE IN CIVIL ENGINEERING

2. BSME-BACHELOR OF SCIENCE IN MECHANICAL ENGINEERING

3. BSIT-BACHELOR OF SCIENCE IN INFORMATION TECHNOLOGY

4. BS-ECE-BACHELOR OF SCIENCE IN ELECTRONICS ENGINEERING

5. BSEE-BACHELOR OF SCIENCE IN ELECTRICAL ENGINEERING

CONFORME:

APPLICANT’S SIGNATURE DATE

- - - - - - - - - TO BE FILLED UP BY AN AUTHORIZED PUP ADMISSION OFFICER - - - - - - - - -
REMARKS:

THIS IS AN AUTO-GENERATED COPY OF YOUR CAEPUP 2022 APPLICATION FORM • VOID IF TAMPERED • VALID ONLY For the First Semester, Academic Year 2023-2024
THIS FORM CONTAINS PERSONALLY IDENTIFIABLE INFORMATION. TO PROTECT YOUR DATA PRIVACY, PLEASE KEEP AND FILE THIS IN A SAFE LOCATION.
TRANSACT AND SUBMIT ONLY TO AN AUTHORIZED PUP ADMISSION OFFICER.

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