Republic of the Philippines

DALUBHASAAN NG LUNSOD NG SAN PABLO

Barangay San Jose, City of San Pablo
ALCUCOA REACCREDITED Level 1

Student No.: 24-13818 REGISTRATION FORM Application No.: EN-2469512

st nd
PROGRAM/COURSE APPLIED FOR: 1 Sem ✓✓ 2 Sem Midyear
LRN:
BS IN BUSINESS ADMINISTRATION A.Y. 2024-2025 (for new students only)
Instructions: Read General and Documentary Requirements. Fill in all the required information. Do not leave an item blank. If item is not
applicable, indicate “N/A”.
PERSONAL INFORMATION

NAME (Last Name) (First Name) Middle Name Maiden Name (for married woman)
DELOS REYES JHAYPEE FUNTANILLA

Date of Birth Permanent Mailing Address/ San Pedro Tiaong Quezon

(MM/DD/YYYY)
1 0 / 2 8 / 2 0 0 6 Zip Code
4325
Age 17 Mobile Number 0 9 6 7 4 8 2 5 9 4 7
Place of Birth Bocaue Bulacan E-mail Address [email protected]
Sex ✓ Male Female Nationality Filipino
Name of Rosalinda Funtanilla Relationship Occupation
Parent/Guardian Grandmother Housewife
Civil Status: Student Type Are you enjoying other educational/ Are you a member of any indigenous
Continuing Old financial assistance? group?
✓ Single Regular Irregular Yes or No ✓ Yes or No ✓
Married ✓ New Enrollee If yes, please specify: Pls. specify_______________________
Widowed Returning Student Are you a solo parent?
Separated Yes No ___________________________ Yes or No ✓
Are you a person with disability?
Yes or No ✓
SCHOOL RECORD
Intermediate Turo Elementary school Year Graduated 04/11/2018
Senior High School Asian Institute of Technology and Education Year Graduated 06/08/2024
College Year Graduated
Highest Year Completed
Last School Attended
COURSES ENROLLED
Course Course Description Units Time Days Section Instructor
No.
Code
1 GE102 Readings in Philippine History 3 3:30-5:00 TTh BSBA-1D
2 GE103 Mathematics in the Modern World 3 5:30-7:00 TTh BSBA-1D
3 DevRead Developmental Reading 3 8:00-9:30 MW BSBA-1D
4 KomFil Kontekstuwalisadong Komunikasyon sa Filipino 3 2:00-3:30 TTh BSBA-1D
5 11:00-
LocHist Local History & Culture 3 TTh BSBA-1D
12:30
6 FinAcctg1
Fundamentals of Accounting 1 and 2 6 9:30-12:30 MW BSBA-1D
&2
7 PATHFit 1 (Physical Activitiy Towards Health
PE1 2 8:00-10:00 T BSBA-1D
and Fitness) Movement Competency Training
8 NSTP1 CWTS/LTS/ROTC 3 2:00-3:30 MW BSBA-1D
Total Number of Units 26
Note: To be filled out by Finance Officer
I HEREBY CERTIFY that all information indicated in this form and on the Student Type: Resident ✓ Non-Resident
documents attached in this application for free tuition 2017 program are true Amount
and correct and that any concealment or misrepresentation of facts therein Tuition fee 3,000
found will adversely affect my application. Other School Fees
Likewise, I am fully aware that DLSP may share such information to Registration fee 100
affiliated or partner organizations as part of its contractual obligations, or Guidance fee 100
with government agencies pursuant to law or legal processes. In this regard, Medical/Dental fee 100
I hereby allow DLSP to collect, process, use and share my personal data in Athletic fee 100
the pursuit of its legitimate academic, research, and employment purposes Library fee 100
and/or interests as an educational institution. Development fee 100
Computer fee 500
_____________________________________ Admission fee 100
(Signature over Printed Name of Applicant) Student Handbook fee 100
Cultural fee 100
__________________ I.D. fee 50
Date Accomplished NSTP fee 150

Approved by:

Prof. Layzon G. Briones, MPA Total Fees 4,600

MS. VRENALI R. TOLENTINO ________________________
Assessed: Certified:
Registrar II Dean

Benjamin F. Maghirang Elibert O. Singson

Account Officer Cashier I

Form No.: DLSP-SCO-UNI–01 Revision No.: 02 Effectivity Date: December 31, 2019 Page 1 of 1