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Republic of the Philippines

Laguna State Polytechnic University


Province of Laguna

APPLICATION FOR COLLEGE ENTRANCE TEST

Instructions: READ ADMISSION AND APPLICATION REQUIREMENTS AT THE BACK PAGE


Fill in all the required information. DO NOT leave an item blank. if item is not applicable, indicate "N/A".

STATUS OF APPLICANT

☑ Freshmen ☐ Transferee ☐ Returnee ☐ Shifter ☐ Continuer

PERSONAL INFORMATION
Name Saavedra Jade Phoenix
AGE DATE OF BIRTH SEX CIVIL STATUS CITIZENSHIP
21 2002-01-17
☐ Male   ☑ Female ☑ Single ☑ Filipino
COMPLETE PERMANENT MAILING ADDRESS
(HOUSE NUMBER) (Street/Subdivision) (Barangay) (Municipality/City) (Province) (Zipcode)

1002 Purok 6-a Bambang Los Baños Laguna 4030

MOBILE NUMBER TRACK/STRAND INTENDED First Choice: Bachelor of Science in EMAIL ADDRESS
COURSE Hospitality Management

09673310707 Second Choice: Bachelor of [email protected]


Science in Hospitality Management

EDUCATIONAL ATTAINMENT

NAME OF SCHOOL SCHOOL ADDRESS TYPE OF SCHOOL YEAR ATTENDED


Bambam Los Baños Laguna 2013
ELEMENTARY:
Bambang Elementary School
☑ Public   ☐ Private

M. Palis St. Brgy Timugan Los Baños 2017


HIGHSCHOOL:
Liceo de Los Baños Laguna ☐ Public   ☑ Private

M. Palis St Brgy Timugan Los Baños 2021


SENIOR HIGH SCHOOL:
Liceo de Los Baños Laguna ☐ Public   ☑ Private

COLLEGE: (For Transferee) From:


☐ Public
To:
☐ Private

Course REASON FOR TRANSFERRING:


RAW SCORE: GWA: GUIDANCE COUNSELOR/GUIDANCE PERSONNEL: DATE FILED:
February 5, 2023
LRN: 136834120699 SIGNATURE OF THE APPLICANT:

Application Number: 117060 LSPU ENTRANCE TEST PERMIT

To be filled-out by applicant
Applicant's Name: Jade Phoenix Saavedra
Intended Course: Bachelor of Science in Hospitality Management
SCHEDULE OF EXAMINATION

Date: ____________ Approved:


Time: ____________ ___________________________________
Room No: ____________ Examiner's/Proctor's Signature

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