Permit Claim Stub

*TO BE FILLED OUT ONLY BY TESTING PERSONNEL AUTHORIZED TO RECEIVE AND/OR PROCESS APPLICATIONS.
TSU-CAT PERMIT/CLAIM STUB

APP #:01-22-12852
Bring the following:
NAME:Charles Benedict Lagrosa Faala
1. Test Permit
COURSE APPLIED:BS Accountancy
BS Civil Engineering 2. 2 pcs. Lead pencil No.2
SCHOOL:Tarlac National High School Main TIME: 08:30:00 - 09:30:00 3. Identification Card
DATE OF TEST: Friday Apr 08, 2022 ROOM NO: COVERED COURT 1 ASSEMBLY MEETING:
VENUE: TSU - Lucinda Campus Beside the Testing Venue
(Covered Court).
NOTE : 1. LATE EXAMINEES will not be allowed to take the TEST. Please come 30 minutes before your scheduled time.
2. Failure to come on the scheduled date and time will mean forfeiture of slot.
Health and Safety Protocols for the Conduct of College Admission Test
· The assembly area and testing venue will be at the Lucinda Campus covered court .
· Gate 1 of the Lucinda Campus will be the entrance and exit points of all examinees.
· Examinees must strictly follow their assigned schedule and they are directed to come at least 30
minutes before their examination.
· Examinees must wear face mask and observe and maintain physical distancing. Additionally, they
should present their vaccination card/ vaccination certificate upon entry to TSU. In the absence of a
vaccination card, a medical certificate shall be presented indicating their ineligibility for vaccination
due to health condition but required to present a valid and negative RT -PCR test result. (Reference:
TSU-DRR-no. 001-22)
· Wear proper and comfortable attire during your examination day. No wearing of short clothing (e.g:
skirt, sando, shorts and slippers)
· Examinees must have their temperature checked and sanitize their hands using alcohol which will be
placed at the entrance point. Examinees are also advised to bring their own alcohol /sanitizer for
immediate sanitation purposes.
· Examinees with 37.8 degree Celsius and above temperature will be sent home and will be given
another schedule for admission test.
· Examinees must fill-up health certificate form which is issued by the Medical Services Office to be
signed by the representative of their Barangay Health Center certifying that they are not PUM ,
COVID-19 suspects, no flu-like symptoms for five days.
· If examinees have signs/symptoms of COVID-19, they must inform the Testing Unit immediately for
the rescheduling of their admission test. Also, they must present their medical certificate signed by a
physician that they are physically healthy and well.
· The College of Criminal Justice Education (CCJE) comfort rooms will be utilized by the examinees.
· All private vehicles and guardians of the examinees are not allowed to enter the TSU Campus
premises. “Drop and go” policy shall be strictly implemented.
· Only examinees during the specific examination time will be allowed to enter the testing venue.
· Examinees must bring their own supplies like pens and pencils. Examinees are not allowed to share
these supplies to other examinees.
· Examinees are not allowed to eat and drink during the examination period.
· Examinees are not allowed to loiter inside the campus before and after the examination.
CERTIFICATION
This is to certify that Mr./Ms. Charles Benedict Lagrosa Faala was not infected or identified
as a close contact of a suspect, probable, and/or confirmed case of COVID-19 in our
community, and he/she is not presently advised to be on home quarantine or isolation.
This further certifies that he/she had no flu-like symptoms for the past five (5) days from the
date of this certification.
Given this _____ day of ____________ at __________________________________

Day Month Barangay
upon request of Mr./Ms. Faala for entry requirement purpose at the Tarlac State University
during his/her scheduled admission test on Friday Apr 08, 2022.
______________________________________________
Signature over Printed Name of
Barangay Health Emergency Response Team (BHERT) /
Rural Health Unit (RHU) Representative
This certification must be signed 1 Day to 2 Days prior your schedule.

Bring and present this during your admission test schedule.

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*TO BE FILLED OUT ONLY BY TESTING PERSONNEL AUTHORIZED TO RECEIVE AND/OR PROCESS APPLICATIONS.

TSU-CAT PERMIT/CLAIM STUB

Given this _ day of at __________________________

This certification must be signed 1 Day to 2 Days prior your schedule.

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