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Application No: 2023-A-40535 Application Date: Mar 8 2023

Approved Residency: Marikina Resident Non-Marikina Resident


Applying for: Undergraduate Program New Freshmen
Desired Program/s
First Choice: BSED Major: (if any) MATH
Second Choice: BSBA Major: (if any) FIMA
Rizol Remuel Billantes
Name
Last Name First Name Middle Name

#26 Yen st Urban Bliss Barangka Marikina City


Present Address
House/Block/Lot No. Street/Subdivision/Village Barangay City/Municipality

Contact No: 09759457433 Email: [email protected] Gender: Male


Age: 21 Birth Date: 9/19/2001 Birth Place: Marikina city
Civil Status: Single Nationality: Filipino With Disability: No
Father's Name: Rizol, Danilo, Tepgos Occupation: Construction worker
Mother's Name: Billantes, Nenita, Ramirez Occupation: House wife
Guardian's Name: Bautista, Jeffrey, Lorente Occupation: Kitchen crew
Number of Sibling/s: 0 Monthly Income of Family: 10000.00 Working Student: Yes

EDUCATIONAL BACKGROUND
School Name Parang elementary school
ELEMENTARY School Address 84 P. Paterno, Parang, Marikina City

Year Graduated 2013


School Name (Junior High) Fortune High School

School Address Santan St, Fortune, Marikina city


Year Graduated 2017
SECONDARY
School Name (Senior High) Fortune High School
School Address Santan St., Fortune, Marikina City

Track/Strand Academic General Academic


School Name

School Address
VOCATIONAL
Degree

Year of Completion
School Name No
School Address
TRANSFEREE
Program

Year Last Attended

Check List of Documents to be Submitted


Two (2) pcs. of recent 2x2 photo (with name tag and in white background, with neutral facial expression, must not be wearing eyeglasses or colored
contact lenses, and with ears exposed if religious customs do not prohibit)
Photocopy of PSA Birth Certificate

Photocopy of Proof of Billing (Meralco, Water, Telephone)


For Marikina Residents Photocopy of any valid Primary Government Issued ID of student/parent
(Voter's ID/Voter's Certification, National ID, Driver's License, UMID ID - SSS/GSIS, Senior Citizen ID, PWD ID)
Grade 12 student expected to graduate
Certificate of Enrollment
at the end of Academic Year 2022-2023

Grade 12 student who graduated prior to Photocopy of Form 138 (Senior High School Report Card Grade 12)
Academic Year 2022-2023
Certificate of Non-issuance of Numerical Grades (Issued by the School Registrar - for Applicants from schools
with non-numerical (Pass/Fail) grades)

Certificate of Rating for Passer of the Philippine Educational Placement Test (PEPT), Alternative Learning
For ALS Passer System (ALS), or Non-Formal Education Accreditation and Equivalency (NFE A&E) Program for non-Secondary
graduates only
Photocopy of Transfer Credentials/Honorable Dismissal, Transcript of Record (TOR) and/or Certified True Copy
For Transferees
(CTC) of Grades
For Married Females Photocopy of Marriage Certificate

I hereby certify that above information given are true as to the best of my knowledge.

Applicant's Signature Over Printed


Name

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