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UREG-QF-02

Republic of the Philippines


CAVITE STATE UNIVERSITY
Don Severino delas Alas Campus 1x1 picture
Indang, Cavite

STUDENT INFORMATION SHEET

Name (please print) Lapura Mith Cyrus Solimanan


Last Name First Name Middle Name

Home Address Josephine Village Lucsuhin Silang Cavite


House No. & Street Barangay Town Province

Landline No. ___________________________ 09066801322


Cellphone No. _________________________

meljelapura@gmail.com
E-mail Address _________________________________________________________________

Course _______________________________ Section ______________________________

Student Classification: /✘/ New / / Continuing / / Transferee / / Cross Enrollee


/ / Shiftee from ____________ / / Returnee

Registration Status /✘/ Regular / / Irregular / / Temporary


01/02/2001
Date of Birth ________________________ Sta. Cruz, Manila
Place of Birth ______________________________
18
Age ______ Male
Sex _______ Seventh Day Nationality ________Civil
Religion ___________ Filipino Single
Status __________
Adventist
Educational Background

Kalubkob Elementary School


Elementary _____________________________________________________________
2013
Year Graduated _______________ /✘/ public / / private
Kalubkob, Silang, Cavite
Address ________________________________________________________________

General Vito Belarmino National High School


High School _____________________________________________________________
2019
Year Graduated _______________ /✘/ public / / private
Kalubkob, Silang, Cavite
Address ________________________________________________________________

For Transferees/Cross Enrollees


School Last Attended ______________________________________________________
Address ________________________________________________________________
==========================================================================
Genita S. Lapura
Parent/Guardian ________________________________________________________________
Lucsuhin, Silang, Cavite
Address ______________________________________________________________________
Sales Agent
Occupation ____________________________________________________________________
09264806331
Landline No._____________________ Cellphone No. __________________________________

_____________________________
Signature of Student

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