Republic of the Philippines

LEGAL EDUCATION BOARD

Manila

INSTRUCTIONS: Accomplish and submit in triplicate to the Legal Education Board by supplying the required
information in the blank spaces and checking the corresponding answer to the items below:

Applicant name: PAULA FRANCESCA A. BARIUAN Application No: Not Applicable

Address: No. 94 Del Rosario Street, Brgy. Centro 2, Tuguegarao City, Cagayan 3500
Email Address: paulabariuan@gmail.com Mobile Number: +639956602600

APPLICATION FOR CONDITIONAL ADMISSION/ENROLLMENT PERMIT

That, I am intending to enroll in the basic law course at the beginning of the First Semester of the
Academic Year 2017-2018 in the law school of CAGAYAN STATE UNIVERSITY:

Did you register in the April 16, 2017 Philippine Law School Admission Test (PhiLSAT)?
[ ] Yes / [X ] No. If yes, indicate your application number: ___________________;
Did you pay the testing fee of Php 1,000.00 to the Center for Educational Measurement, Inc (CEM)? [ ]
Yes / [X ] No
Are you seeking exemption from paying the testing fee in the next scheduled PhiLSAT for having been
prevented from taking the test last April 16, 2017 due to the inclement weather?
[ ] Yes / [X] No

That, I did not take the PhiLSAT administered on April 16, 2016.
That, I did not register, and/or pay the testing fee, and take the PhiLSAT on April 16, 2017 since I was not
permitted a leave of absence from work for the examination.
That, if conditionally admitted by CAGAYAN STATE UNIVERSITY COLLEGE OF LAW and enrolled in the
basic law course by virtue of a permit issued in accordance with LEB Memorandum Order No. 11, Series of 2017
pursuant to this application, I expressly agree that my said conditional admission and enrollment shall be subject
to the following express conditions, as well as those in the UNDERTAKING attached hereto as Annex A:
a. I shall take the next scheduled Philippine Law School Admission Test (PhiLSAT);
b. If I fail to take the next scheduled PhiLSAT for any reason, my conditional admission and enrollment
shall be automatically revoked and I shall be barred from enrolling in the following semester;
c. If I take the next scheduled PhiLSAT but score below the passing/cut-off score, my conditional
admission shall also be revoked and I shall be barred from enrolling in the following semester, unless
the law school expressly admits me in the exercise of the discretion given under Section/Paragraph
14 of LEBMO No. 7, Series of 2016, subject to the requirements of the same provision; and
d. In the event that my conditional admission and enrollment is subsequently revoked for either failing
to take the next scheduled PhiLSAT, or I score below the passing/cut-off score in the PhiLSAT, I shall
not be entitled to the reversal of the school fees assessed and/or refund of the school fees paid.

Signed this 14TH day of June, 2017 in Tuguegarao City, Cagayan.

PAULA FRANCESCA A. BARIUAN

Applicant

SUBSCRIBED AND SWORN to before me this 14TH day of June, 2017 in Tuguegarao City, Cagayan by
affiant PAULA FRANCESCA A. BARIUAN, who proved to me his identity by exhibiting her DBP Employee ID No.
0201953-PAU, issued on August 29, 2009.

NOTARY PUBLIC
Doc No. ____;
Page No: ____;
Book No. _____;
Series of 2017.