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    Republic of The Philippines Mariano Marcos State University Ilocos Norte Certificate of Registration

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    Dharen Rojan Aguiran Tagalicud
    This document is a Certificate of Registration from Mariano Marcos State University for the student Dharen Rojan Aguiran Tagalicud for the First Semester of the 2019-2020 Academic Year. It lists the courses taken, schedule, fees, and mode of payment. It also includes an application for Tertiary Education Subsidy under RA 10931 signed by the student and parents.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Republic of The Philippines Mariano Marcos State University Ilocos Norte Certificate of Registration

    Uploaded by

    Dharen Rojan Aguiran Tagalicud
    40 views2 pages
    This document is a Certificate of Registration from Mariano Marcos State University for the student Dharen Rojan Aguiran Tagalicud for the First Semester of the 2019-2020 Academic Year. It lists the courses taken, schedule, fees, and mode of payment. It also includes an application for Tertiary Education Subsidy under RA 10931 signed by the student and parents.

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    This document is a Certificate of Registration from Mariano Marcos State University for the student Dharen Rojan Aguiran Tagalicud for the First Semester of the 2019-2020 Academic Year. It lists the courses taken, schedule, fees, and mode of payment. It also includes an application for Tertiary Education Subsidy under RA 10931 signed by the student and parents.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    40 views2 pages

    Republic of The Philippines Mariano Marcos State University Ilocos Norte Certificate of Registration

    Uploaded by

    Dharen Rojan Aguiran Tagalicud
    This document is a Certificate of Registration from Mariano Marcos State University for the student Dharen Rojan Aguiran Tagalicud for the First Semester of the 2019-2020 Academic Year. It lists the courses taken, schedule, fees, and mode of payment. It also includes an application for Tertiary Education Subsidy under RA 10931 signed by the student and parents.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    Form 5 (Revised 2017) Republic of the Philippines

    MARIANO MARCOS STATE UNIVERSITY


    Ilocos Norte
    CERTIFICATE OF REGISTRATION
    2019-07-29
    Student
    : 19-020007 Semester : First
    Number
    Name : TAGALICUD, DHAREN ROJAN AGUIRAN Academic Year : 2019-2020
    Degree : BS in Computer Science Year / Section : 1 - A
    Course Code Units Time Day Room/College ASSESSMENT
    NSTP 01 3.00 8-11 SAT
    PE 01 2.00 3-5 TH TBA Description Amount
    Fil 01 3.00 4-5 MWF RM 15 CAB
    SocSc 02 3.00 3-4 MWF RM 15 CAB
    STS 01 3.00 8-9 MWF 209 CAS Tuition Fee 1,700.00
    Registration Fee 100.00
    CMPSC 100 3.00 9-10/11-2 TTH/TTH 209/R1 CAS/ITC
    Library Fee 150.00
    CMPSC 111 3.00 9-10/11-2 MW/MW 209/R1 CAS/ITC Medical/Dental Fee 50.00
    Total Units : Athletic Fee 65.00
    20.0 Cultural Development Fee 50.00
    Mode of Payment Guidance Fee 40.00
    Comp Lab Units : 2.0
    Non-Comp Lab Units : 0.0 Alay Lakad Fee (Sports 15.00
    Status: Regular Enhancement Fee)
    SCUAA Fee 25.00
    Full Payment Php 0.00 Student Body Organization Fee 30.00
    Mutual Aid Fund 25.00
    University Organ Fee 60.00
    Group Insurance Fee 30.00
    1st Installment Php 0.00 Entrance Fee 50.00
    Comp Laboratory Fee 900.00
    School ID Fee 100.00
    Internet Fee 100.00
    2nd Installment Php 0.00 NSTP Fee 150.00
    TOTAL(Free): Php 3,640.00

    3rd Installment Php 0.00 Scholarship: --NONE--

    RA 10931, Universal Access to Quality Tertiary Education Act of 2017 Php 3,640.00
    YOU ARE NOW OFFICIALLY ENROLLED

    Date & time of enlistment: Mon, Jul 29, 2019 12:29 AM


    Date & time approved: Mon, Jul 29, 2019 12:15 PM

    NOTE: Submit Form 5 and TERTIARY EDUCATION SUBSIDY Form (signed by Parents only) to your Department on the first day of classess.

    DATA PRIVACY CONSENT

    I explicitly and unambiguously consent to the collection, processing and storage of my personal data by MMSU for the purpose(s)
    described in the MMSU Data Privacy Notice (http://www.mmsu.edu.ph/about/mmsu-dataprivacy-notice).

    Signature of Student
    Republic of the Philippines
    MARIANO MARCOS STATE UNIVERSITY
    City of Batac, Ilocos Norte

    APPLICATION TO AVAIL TERTIARY EDUCATION SUBSIDY


    (RA 10931, Universal Access to Quality Tertiary Education Act of 2017)

    I DHAREN ROJAN AGUIRAN TAGALICUD ,a student of MMSU, freely and voluntarily, and not under any form of duress, and with
    the knowledge and consent of my parents (or guardian), as indicated by their respective signatures below, hereby apply for TERTIARY
    EDUCATION SUBSIDY, as provided under RA 10931, the Universal Access to Quality Tertiary Education of 2017, as follows:

    ☐ TES 2: Educational expenses, which I am qualified to by reason of my status as a financially challenged student.
    ☐ TES 3a: Additional allowance for special services, personal assistance, transportation, equipment and supplies, which I am
    qualified to by reason of my standing as a PWD student.
    ☐ TES 3b: Additional one-time benefit to cover cost of obtaining professional license or certificate for the first-time, such as
    notarial fees, review classes fees, insurance premium and documentary fees.

    The student and parents declare, promise and guaranty that all required supporting documents will be submitted, and any and all
    amounts issued and received by reason hereof, shall be solely and exclusively spent, disbursed or used for the purpose for which it
    was granted.

    For the Academic Year 2019-2020 , First semester.

    FULL NAME OF STUDENT: DHAREN ROJAN AGUIRAN TAGALICUD STUDENT NO.: 19-020007
    PERMAMENT ADDRESS: San Lorenzo (Pob.), BANGUI, ILOCOS NORTE
    DEGREE PROGRAM: BS in Computer Science YEAR LEVEL: 1

    __________________________
    Signature of Student

    RONIE TAGALICUD SYLVIA AGUIRAN


    Printed Name and Signature of Father Printed Name and Signature of Mother
    ☐ 1. Certificate of residency with name of student applicant, address & date of issuance. Duly signed by the Barangay Captain
    with dry seal.
    ☐ 2. Certificate of Non-Filing of Income Tax Return/BIR Form 2316/ITR if applicable.
    ☐ 3. PWD ID /Certification from the National Council for Disabilities Affairs (NCDA) specifying the disability(s) for TES 3a
    applicants only.

    CERTIFICATION

    This will serve to certify that the provisions of Republic Act No 10931, the Universal Access to Quality Tertiary Education of 2017,
    were explained to above-named student, and that the student in turn explained this document, the benefits he/she applied to, and the
    corresponding duties obligations thereunder, to his/her parents, and the latter gave consent to this application.

    This ___ day of _____________________ 2019, City of Batac, Ilocos Norte.

    ____________________________________
    Registrar
    NOTE: If a guardian signs instead of a parent/s, please provide additional information:

    1. Why the parent/s could not sign?


    _______________________________________________________________
    2. What is the (blood) relationship between the student and guardian?
    _______________________________________________________________

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