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New Student Enrollment Form

The document is a blended learning enrollment form for Cebu Technological University, detailing personal, educational, and entrance data required for enrollment. It includes sections for student information, educational background, and assessment of fees. The form is intended for new, old, or transferee students and requires certification of the accuracy of the provided information.

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Jonathan Judaval Cartilla
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22 views2 pages

New Student Enrollment Form

The document is a blended learning enrollment form for Cebu Technological University, detailing personal, educational, and entrance data required for enrollment. It includes sections for student information, educational background, and assessment of fees. The form is intended for new, old, or transferee students and requires certification of the accuracy of the provided information.

Uploaded by

Jonathan Judaval Cartilla
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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Republic of the Philippines

CEBU TECHNOLOGICAL UNIVERSITY


MAIN CAMPUS
M. J. Cuenco Avenue Cor. R. Palma Street, Cebu City, Philippines
Website: http://www.ctu.edu.ph E-mail: [email protected]
Phone: +6332 402 4060 loc. 1120

COLLEGE OF EDUCATION

CTU - BLENDED LEARNING ENROLLMENT FORM

Date: Academic Year:


st ND rd
[ ] New [ ] Old [ ] Transferee Term: [ ] 1 [ ]2 [ ]3
Student ID Number: ______________________
Degree Program :
Residency: Major :
[ / ] Cebu-based [ ] Within Phils. [ ] Foreign/Based Abroad

PERSONAL DAT A
Name: Age: Gender: [ ] Male [ ] Female
(Last Name) (First Name) (Middle Name)
Date of Birth: Place of Birth: Civil Status: [ ] Single [ ] Married Citizenship:
Home Address: Tel. No.: Email:
Present Occupation/Position: _ School/Company:
School/Company Address: Tel. No.:
Name, Address, and Tel. No. of person to be notified in case of emergency:

EDUCATIONAL BACKGROUND
School Academic Year Honors/Degree Received
Elementary :
High School :
College :
Post Graduate :

ENTRANCE DAT A:
[ ] Form 138-A or TOR (for Transferee) [ ] Birth Certificate [ ] Certificate of Transfer Credentials
[ ] Certificate of Good Moral [ ] Medical Certificate (for Transferees)
I hereby certify that all entries are true and solemnly swear to abide by the laws. Policies, rules and regulations set forth by
the college.
_
Student Signature over Printed Name

CASHIER’S COPY
Name: Gender: Course/Yr. & Sec. I.D. Number:
Course Nomenclature Course Description Unit/s

Enrollment Committee/COED Staff

STUDENT’S COPY
Name: Gender: Course/Yr. & Sec. I.D. Number:
Course Course Description Unit/s Instructor
Nomenclature

Enrolment Committee/Clinic
REGISTRAR’S COPY
Name: Gender:
Course: Year Level: Section:
Course Nomenclature Course Description Unit/s

Total

Enrolment Committee Cashier / EDP

APPROVED BY:

Registrar Date of Registration

ASSESSMENT OF FEES
CHARGES QTY AMOUNT TOTAL O.R. NO. DATE
AMOUNT

Application Fee:
[ ] Cebu-based
[ ] Outside Cebu, but within the Phils.
[ ] Foreign/Based Abroad
Tuition Fee:
[ ] Cebu-based
[ ] Outside Cebu, but within the Phils.
[ ] Foreign/Based Abroad
Instructional Materials Fee
Orientation Fee
Miscellaneous Fee
Change of Matriculation Fee
[ ] Enrollment in additional course
[ ] Substitution of one course for another
[ ] Cancellation of a course
Request for Transcript of Records
[ ] First Copy
[ ] Recopy
[ ] Certification
Educational Development Fee
Telecommunications Support and
Development Fee
TOTAL PHP
TOTAL US $

VALIDATED
Date:
Signature:

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