Registrar's Copy

REGISTRATION FORM
2 x 2 Picture
Campus: Recto School Year: 2024-2025 Semester: First
The undersigned hereby applies for enrollment, promise to pay all fees, and abide by the
school's rules and regulations.
Name: VALENCERINA JERICHO PADASAS Student No. A122A0253
(Last Name) (First Name) (Middle Name)

Course: Bachelor of Science in Information Technology Section: RECBSITM81 Credentials Submitted

Address: 1037 A-F yuseco St. Tondo Manila
Form 138
(Blk. No.) (Street) (Brgy.) (District) (City/Municipality)
Form 137-A
PSA Birth Certificate
(Province) (Region) (Zip Code)
(Photocopy)
Date of Birth: July 17, 2002 Birth Place: MANILA Civil Status: Single
Sex: Male Nationality: Filipino Contact No.: 09774180583 Email Address: [email protected]
Good Moral Certificate
Person to notify in case of Emergency Diploma (Photocopy)
Guardian/Parent: Relation: 3
Address: 1037 A-F Yuseco St. Tondo Manila Contact Number: N/A
Educational Attainment
School Name Year Graduated Course/LRN
College/Vocational:
High School: 136446080480
Amount Paid: Php 15,000.00
O.R. Number: 0044451 Student's Signature
Assessed by: VALENCERINA, JERICHO PADASAS December 06, 2022
Date

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Student's Copy

CERTIFICATION OF ENROLLMENT
2 x 2 Picture
Campus: Recto School Year: 2024-2025 Semester: First
This Certifies that JERICHO P. VALENCERINA is enrolled in the
following course and subjects.
Course: Bachelor of Science in Information Technology Section: RECBSITM81

Amount Paid: Php 15,000.00 Student No. A122A0253

Note: O.R. Number: 0044451
No Refund for payments made on installment Assessed by: VALENCERINA, JERICHO PADASAS Certified by:
basis.Failure to abide the payment schedule may result to
removal from the class list. For full payments made prior Date: December 06, 2022
to class opeing; 100% refund before the start of classes, School Registrar
75% refund the 1st week of classes, 50% refund during
the 2nd week of classses, No refund after the 2nd week of
classes.
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Exam Validation

Prelim Midterm Pre-Final Final

Proctor's Signature Proctor's Signature Proctor's Signature Proctor's Signature
 Subject Enrollment and Assessment of Fees
Name: JERICHO P. VALENCERINA Course Code: Bachelor of Science in Information Technology Section: RECBSITM81
Enrollment of subjects:
Subject Code Descriptive Title Unit Day Time Room
BSITCP1 Capstone Project and Research 1 3 M 10:00AM-
NETWOR1 Networking 1 3 M 01:00PM-
QUANMET Quantitative Methods 3 W 05:00PM-
SISPROP Social Issues and Professional Practice 3 T 07:00PM-
SYSADMA Systems Administration and Maintenance 3 W 01:00PM-
-
-
-
-
-
-
-
Total Number of Units: 15
Assessed By: VALENCERINA, JERICHO PADASAS Approved By: Student's Signature:
Assessment of Fees

Tuition Fee: 6,450.00 Others: 1,700.00 Discount (if any): 6,450.00

Registration: 1,750.00 State Reason for Discount:
Cash
Laboratory: 3,450.00
Installment Med/Insurance: 350.00 Net Amount: 15,000.00
Amount Paid: 15,000.00
Availed Scholarship: Balance: 0.00
Total Fee: 21,450.00

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Enrolled Subjects Assessment of Fees
Subject Code Unit Day Time Room Remarks Cash Installment Availed Scholarship:
BSITCP1 3 M 10:00AM-
NETWOR1 3 M 01:00PM-
Tuition Fee 6,450.00 Others: 1,700.00
QUANMET 3 W 05:00PM-
Registration 1,750.00
SISPROP 3 T 07:00PM-
Laboratory 3,450.00
SYSADMA 3 W 01:00PM-
Med/Insurance 350.00 Total Fee 21,450.00
- Discount (if any): 6,450.00
- State Reason for Discount:
-
- Net Amount: 15,000.00
Amount Paid: 15,000.00
-
- Balance: 0.00
(Note: Notify the office of the Registrar if incase subjects are to be dropped.)
Assessed by: Approved By:
VALENCERINA, JERICHO PADASAS

Student Signature:

For Clearance Purposes Schedule of Payments

Department Signature Date Due Date Amount
Library 1st Payment 15,000.00
HRS Laboratory 2nd Payment 0.00
Technical Laboratory 3rd Payment 0.00
Accounting 4th Payment 0.00
Register 5th Payment 0.00
ACSUCOM 6th Payment 0.00
7th Payment ( 0.00
8th Payment 0.00
9th Payment 0.00