Scribd
Upload
33 views

Admission Application

Uploaded by

denzorenavy17
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
33 views

Admission Application

Uploaded by

denzorenavy17
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 2

Republic of the Philippines

PALOMPON INSTITUTE OF TECHNOLOGY


Palompon, Leyte
GUIDANCE OFFICE
Tel. No. (053) 555 - 8458

APPLICATION FORM
COLLEGE ADMISSION EXAMINATION
School Year: 2025 - 2026

Instruction: Please print this admission application form in an A4 Size paper.


Personal Information Application No.: 2569-0905-354
A grade 12 student EXPECTED TO GRADUATE at the end of
Application Category:
AY 2024-2025
Complete Name: DENZO, RENAVY, BAZARTE
Sex at Birth: FEMALE
Nationality: FILIPINO
Contact Information
Address: Washington Street, Palompon, Leyte 6538
Contact Number: (63) 0931-7286-969
Email Address: [email protected]
School Last Attended (Where you last attended/are currently completing secondary level education)
School Name: Palompon National High School
Address: Palompon, Leyte
Degree/Course: 11
Sr. High Track: Academic Track - Humanities And Social Sciences (HUMMS)
Preferred Program of Choice
Program Name: Bachelor of Secondary Education - Filipino

Data Privacy Consent (Please check the appropriate statement)


______ I am a student-applicant who is 18 or over 18 years of age.
______ I/We am/are the parent/s or legal guardian of a student-applicant who is a minor (Below 18 years old.).

I/We warrant that I/we have read, understood all the provisions and agreed with its full
implementation:
- Republic Act No. 10173, or the Data Privacy Act of 2012, and other relevant Philippine laws apply to the collection and processing of my/
applicant’s personal data.
- I/We understand that by applying for admission to Palompon Institute of Technology, I/we give permission to the institution to collect, use
and further process information collected, acquired or generated.
- I/We am/are aware that said personal information will be accessed and used by the Admissions personnel for the purpose of carrying out their
duties and by other school personnel who are involved in the evaluation of application for admission.
- By providing personal information to the Admission Office, I/we am/are confirming that the data is true and correct. I/We understand that
Palompon Institute of Technology reserves the right to revise any decision made on the basis of the information I/we provide should the
information be found to be untrue and incorrect.

I hereby certify that all information supplied in this application form are true, complete and accurate. I understand that any false or incomplete
entry may cause my disqualification for admission.

I have read and understood the Institute's Data Privacy Statement and express my consent for the Palompon Institute of Technology to collect,
record, organize, update or modify, retrieve, use, consolidate, block, erase or destroy my personal data.

I hereby affirm my right to be informed, object to processing, access and rectify, suspend or withdraw my personal data, and be indemnified in
case of damages pursuant to the provisions of the Republic Act No. 10173 of the Philippines or Data Privacy Act of 2012 and its corresponding
Implementing Rules and Regulations.

Signature over Printed Name Date and Time


Republic of the Philippines
PALOMPON INSTITUTE OF TECHNOLOGY
Palompon, Leyte
GUIDANCE OFFICE
Tel. No. (053) 555 - 8458

For Grade 12 Expected to Graduate at the end of AY 2024 - 2025 or Grade 12 student who graduated from
SHS prior to AY 2024 - 2025
2x2 ID PICTURE (with colored/white background and nametag LAST NAME, FIRST NAME MIDDLE NAME)
GRADE 11 REPORT CARD - 1ST AND 2ND SEMESTER (must be Certified True Copy and has your name on every page)
GRADE 12 REPORT CARD 1ST SEMESTER (if requested by the Guidance Office/Department)
PSA Birth Certificate (NSO/Live birth will not be accepted)
VALID ID (must have your name, picture and signature)

Second Coursers, Transferee from other College/Universities


2x2 ID PICTURE (with colored/white background and nametag LAST NAME, FIRST NAME MIDDLE NAME)
TRANSCRIPT OF RECORDS/TOR (must be Certified True Copy and has your name on every page)
PSA Birth Certificate (NSO/Live birth will not be accepted)
VALID ID (must have your name, picture and signature)

A transferee of the same program from PIT Tabango to PIT Main


2x2 ID PICTURE (with colored/white background and nametag LAST NAME, FIRST NAME MIDDLE NAME)
CERTIFICATE OF GRADES/COG (must be from the Registrar's Office)
PSA Birth Certificate (NSO/Live birth will not be accepted)
VALID ID (must have your name, picture and signature)

Shifter to Maritime Program (Applicants currently enrolled from PIT only)


2x2 ID PICTURE (with colored/white background and nametag LAST NAME, FIRST NAME MIDDLE NAME)
CERTIFICATE OF GRADES/COG (must be from the Registrar's Office)
PSA Birth Certificate (NSO/Live birth will not be accepted)
VALID ID (must have your name, picture and signature)

Vision

A Premier Polytechnic State University

Mission

To strengthen its capacity of producing highly skilled, competent, and world-class human resources, responsible to fulfill stakeholder
needs, goals of the national development and ASEAN integration, for the attainment of a good quality of life with the guidance and
providence of God

Goal

Make PIT a premier polytechnic educational institution where students are trained to excel in their areas of specialization through quality
instruction, product-based research, need-driven extension and accessible production programs for a heightened socio-economic
development and improved quality life in a fast changing society.

Core Values

The Institute’s core values serve as the fundamental elements which will make the members of the community to achieve high level of
productivity and the students to excel in their fields of endeavors, through:

Excellence: Transformational Leadership, Personnel Empowerment, Efficiency and Effectiveness, Complementation and
Collaboration, and Quality of Service
Integrity: Honesty and Sincerity, Justice and Equity, Prudence, Transparency, and, Respect and Self-Discipline
Creativity: Courage,Relevance, Responsiveness, Versatility and Flexibility, and Initiative
Commitment: Sense of Belongingness, Teamwork and Cooperation, Involvement and Motivation, Organization Relations, and
Unity
Institutional Social Responsibility: Social Awareness, Community Development, and Technology Transfer
Exceeding Expectations: Be the best in all undertakings

You might also like