Republic of the Philippines

CENTRAL MINDANAO UNIVERSITY

University Town, Musuan, Maramag, Bukidnon

OFFICE OF ADMISSIONS, SCHOLARSHIPS AND PLACEMENT

APPLICATION FORM
SENIOR HIGH SCHOOL ADMISSION TEST (SHSAT)

Testing Fee: Php 200.00 for 2nd courser (Pay at the CMU Cashier's Application No: SHSAT-20200204M5EkpLD59A
Office)

O.R. NO. __________ ROOM NO.    4   

A. APPLICANT SEX: MALE AGE: 15

Name: LUMBAYAN WROWEE CANGAS

1X1
(Family Name) (First Name) (Middle Name)
Recent Photo
BIRTHDATE: 2004-03-26 CITIZENSHIP: FILIPINO
BIRTH PLACE: BETHEL BAPTIST HOSPITAL MALAYBALAY CITY RELIGION: BAPTIST
HOME P4 PARADISE CABANGLASAN BUKIDNON , PARADISE, ZIP CODE: 8723
ADDRESS CABANGLASAN, BUKIDNON
SCHOOL NAME CPNHS-MAIN MOBILE NO.: 09354476351
:
SCHOOL CABULOHAN CABANGLASAN BUKIDNON LRN : 126301090034
ADDRESS :
 B. TRACK AND STRAND OF YOUR CHOICE
  Track 1st choice:   ACADEMIC   Strand 1st choice:   SCIENCE, TECHNOLOGY,
ENGINEERING AND
MATHEMATICS - STEM
  Track 2nd choice:   ACADEMIC   Strand 2nd choice:   ACCOUNTANCY, BUSINESS AND
MANAGEMENT - ABU
  C. FAMILY   FATHER   MOTHER
  FULL NAME   REYNALDO MAGASO LUMBAYAN   EMELIE CABAñAS CANGAS
  EDUCATIONAL ATTAINMENT   COLLEGE   COLLEGE
  OCCUPATION   BISHOP   HOUSE WIFE
 D. CERTIFICATION (PRINCIPAL OR SCHOOL DIRECTOR/GUIDANCE COUNSELOR)
       I hereby certify that the applicant is [  ] a Junior High School graduate [  ] a candidate for Junior High School completion of CPNHS-
MAIN SY:______________

_________________________________ Date:_________________________________
Signature Over Printed Name Designation:_________________________________

 E. APPLICANT'S SIGNATURE  F. ACTION TAKEN (to be filled up by the CMUCAT Board)
       I hereby certify that all information above are true and correct to the
best of my knowledge. Furthermore, I hereby agree and consent that the [  ] APPROVED [  ] DISAPPROVED [  ] PENDING
Office of Admissions, Scholarships, and Placement (OASP) may utilize my
information in posting of the result and billing purposes.

Date: _________
WROWEE LUMBAYAN _________________________________
Signature Over Printed Name CMUCAT BOARD
Date: ___________

NOTE: Subject to revocation if the records upon which the approval is based are found incorrect/invalid
----------------------------------- ----------------------------------- -----------------------------------

SENIOR HIGH SCHOOL ADMISSION TEST (SHSAT) PERMIT

O.R. No.: __________________________ Application ID. : SHSAT-20200204M5EkpLD59A
1X1 NAME OF EXAMINEE: WROWEE LUMBAYAN
Recent Photo DATE OF TEST: 2020-03-01 TIME. : 9:00 AM
ROOM NO.:    4    LRN: 126301090034
PLACE OF TEST: CMU-College of Education

__________________________
CMUCAT BOARD
__________________________
Signature: Date Filed : 2020-02-04
Note: 1. Present this permit to the PROCTOR during the exam. 2. No SHSAT permit, No Exam.
(REPRODUCTION OF THIS FORM IS ALLOWED BUT NOT FOR SALE)

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