Don Mariano Marcos Memorial State University

OPEN UNIVERSITY SYSTEM

San Fernando City, La Union
(072) 242 -3608
ous@dmmmsu.edu.ph
https://www.facebook.com/DMMMSUOpenUniversity

APPLICATION FOR GRADUATION FORM

Date: JUNE 1, 2020 Application Number: __________________
CP No: 09383260449 Email Address: edrinroy@gmail.com
INSTRUCTIONS:
1. Complete all information as requested
2. Print all information legibly.

PERSONAL INFORMATION:

Name of Applicant (EXACTLY as it should appear on the Diploma and Transcript of Records):
SY EDRIN ROY CACHERO

Last Name First Name Middle Name

PERMANENT ADDRESS (To appear by your name in the Commencement Program):

194 SAN ENRIQUE ROAD, LIOAC NORTE, NAGUILIAN, LA UNION, 2511

No./Street/Zone/Barangay City/Municipality Province

Place of Birth: MUNTINLUPA CITY, METRO MANILA Date of Birth: JANUARY 31, 1993
Town Province Month Day Year

Note: Submit a Photocopy of BIRTH CERTIFICATE issued by the NATIONAL STATISTICS OFFICE (NSO). If discrepancies were noted,
submit Request for Change/Correction of Information Form together with the required supporting legal document/s to the Office of
the Registrar.

ACADEMIC INFORMATION:

Degree/Program: DIPLOMA IN LOCAL GOVERNMENT AND REGIONAL ADMINISTRATION

Major (if applicable): _____________________________________________________________________________________
Subjects currently enrolled:

Course No. Course Title Units

Remarks

DAFDADADA
214
PUBLIC POLICY, PROGRAM AND PROJECT ADMINISTRATION 3 UNITS

Thesis Title (if applicable): ________________________________________________________________________________

Did you cross-register in any institution? ____ Yes / No? If yes, specify the name and address of the institution and the subject
cross-enrolled:

Name and Address of the Institution: ________________________________________________________________________

Subjects cross-enrolled:

Course No. Course Title Units

Remarks

EDRIN ROY C. SY (SGD.)

Signature of Student
FINAL EVALUATION

Name: EDRIN ROY C. SY Course: DIPLOMA IN LOCAL GOVERNMENT

Applicant is eligible to graduate: _______ Yes _______ No. If No, state the reason why:
Reason/s: _________________________________________________________________________________________________________
Deficiency/ies:

Evaluated by:

____________________________
REMEDIOS MAJA C. TABUDLO
Registrar

GRADUATION IS SUBJECT TO THE APPROVAL OF THE ACADEMIC COUNCIL AND CONFIRMATION OF THE BOARD OF REGENTS.