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This document is an application form for the Senior High School Admission Test (SHSAT) at Central Mindanao University. It contains information about the applicant, Cybelle Jayne Corpuz Non, including her biographical details, family information, educational history, and signature certifying that the information provided is true and correct. It also notes her preference for the academic track with a science, technology, engineering and mathematics strand. At the bottom is a permit issued to Cybelle authorizing her to take the SHSAT exam on March 1, 2020 at 9:00 AM in room 1 at the CMU College of Education building.

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Christian Jay Vega Corpuz
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143 views2 pages

Jen

This document is an application form for the Senior High School Admission Test (SHSAT) at Central Mindanao University. It contains information about the applicant, Cybelle Jayne Corpuz Non, including her biographical details, family information, educational history, and signature certifying that the information provided is true and correct. It also notes her preference for the academic track with a science, technology, engineering and mathematics strand. At the bottom is a permit issued to Cybelle authorizing her to take the SHSAT exam on March 1, 2020 at 9:00 AM in room 1 at the CMU College of Education building.

Uploaded by

Christian Jay Vega Corpuz
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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2/3/2020 DOORSTEP

Republic of the Philippines


CENTRAL MINDANAO UNIVERSITY
University Town, Musuan, Maramag, Bukidnon

OFFICE OF ADMISSIONS, SCHOLARSHIPS AND PLACEMENT

APPLICATION FORM
SENIOR HIGH SCHOOL ADMISSION TEST (SHSAT)

Testing Fee: Php 200.00 for 2nd courser (Pay at the CMU Cashier's Application No: SHSAT-20200203qNchfgBCe9
Office)

O.R. NO. __________ ROOM NO.    1   

A. APPLICANT SEX: FEMALE AGE: 16

Name: CORPUZ NON CYBELLE JAYNE VEGA


1X1
(Family Name) (First Name) (Middle Name)
Recent Photo
BIRTHDATE: 2003-06-24 CITIZENSHIP: FILIPINO
BIRTH PLACE: VELENCIA BUKIDNON RELIGION: CATHOLIC
HOME P-7 HALAPITAN SAN FERNANDO BUKIDNON , HALAPITAN POB., ZIP CODE: 8711
ADDRESS SAN FERNANDO, BUKIDNON
SCHOOL HALAPITAN NATIONAL HIGH SCHOOL MOBILE NO.: 09267893764
NAME :
SCHOOL P-7 HALAPITAN SAN FERNANDO BUKIDNON LRN : 126753090046
ADDRESS :
 B. TRACK AND STRAND OF YOUR CHOICE
  Track 1st choice:   ACADEMIC   Strand 1st choice:   SCIENCE, TECHNOLOGY,
ENGINEERING AND
MATHEMATICS - STEM
  Track 2nd choice:   ACADEMIC   Strand 2nd choice:   GENERAL ACADEMIC STRAND -
GAS
  C. FAMILY   FATHER   MOTHER
  FULL NAME   VERNIE SAREN CORPUZ   DECEASED
  EDUCATIONAL ATTAINMENT   BACHELORS DEGREE   DECEASED
  OCCUPATION   POLICE OFFICER   DECEASED
 D. CERTIFICATION (PRINCIPAL OR SCHOOL DIRECTOR/GUIDANCE COUNSELOR)
       I hereby certify that the applicant is [  ] a Junior High School graduate [  ] a candidate for Junior High School completion of HALAPITAN
NATIONAL HIGH SCHOOL SY:______________

_________________________________ Date:_________________________________
Signature Over Printed Name Designation:_________________________________

 E. APPLICANT'S SIGNATURE  F. ACTION TAKEN (to be filled up by the CMUCAT Board)
       I hereby certify that all information above are true and correct to the
best of my knowledge. Furthermore, I hereby agree and consent that the [  ] APPROVED [  ] DISAPPROVED [  ] PENDING
Office of Admissions, Scholarships, and Placement (OASP) may utilize my
information in posting of the result and billing purposes.

Date: _________
CYBELLE JAYNE CORPUZ NON _________________________________
Signature Over Printed Name CMUCAT BOARD
Date: ___________

NOTE: Subject to revocation if the records upon which the approval is based are found incorrect/invalid
----------------------------------- ----------------------------------- -----------------------------------


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2/3/2020 DOORSTEP
SENIOR HIGH SCHOOL ADMISSION TEST (SHSAT) PERMIT
O.R. No.: __________________________ Application ID. : SHSAT-20200203qNchfgBCe9
1X1 NAME OF EXAMINEE: CYBELLE JAYNE CORPUZ NON
Recent Photo DATE OF TEST: 2020-03-01 TIME. : 9:00 AM
ROOM NO.:    1    LRN: 126753090046
PLACE OF TEST: CMU-College of Education

__________________________
CMUCAT BOARD
__________________________
Signature: Date Filed : 2020-02-03
Note: 1. Present this permit to the PROCTOR during the exam. 2. No SHSAT permit, No Exam.
(REPRODUCTION OF THIS FORM IS ALLOWED BUT NOT FOR SALE)

CMU-F-1-ASP-003 03 JUNE 2019 REV. 0 Page 1 of 1


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