Republic of the Philippines
CAVITE STATE UNIVERSITY
CCAT Campus
Rosario, Cavite
APPLICATION FORM FOR ADMISSION
Generated: 2/2/2025 17:15:32
Admission Control Number- 117806 - 1st Semester 2025-2026
Campus : CvSU-CCAT
Entry: NEW Type: K12 (SHS GRADUATE) Applicant Type: FILIPINO
Strand: HUMSS LRN: 124955110020
Preferred Course
Bachelor of Secondary Education (BSE) - Mathematics
Final Average: 92
1st Quarter: 90 2nd Quarter: 92 3rd Quarter: 91 4th Quarter: 92
Personal Information
Name: JOSOL, DIANA JANE RODA Sex: FEMALE
Address: B19 L53 PASINAYA NORTH TIMALAN BALSAHAN, NAIC, CAVITE, 4110
Email: josoldianajane@gmail.com Mobile: 09927214826
Birthdate: 9/27/2006 Nationality: FILIPINO Civil Status: SINGLE
PWD: No Indigenous: No
Family Background
Contact Occupation
Father: PETER L. JOSOL 09205302111 PPRODUCTOIN OPERATOR
Mother: JENNELYN RODA 09205302111 HOUSEWIFE
Guardian: PETER JOSOL 09205302111 PRODUCTION OPERATOR
Educational Background
Elementary:
TINGGABULONG DIMATALING Public
TINGGABULONG ELEMENTARY SCHOOL 2018
ZAMBOANGA DEL SUR
High School:
TINGGABULONG DIMATALING Public
TINGGABULONG NATIONAL HIGH SCHOOL 2022
ZAMBOANGA DEL SUR
Senior High School:
AMAYA SCHOOL OF HOME INDUSTRIES SAHUD-ULAN, TANZA, CAVITE 2024 Public
Previous School Attended:
Medical History Information
Medications:
Medical Condition/s:
I hereby certify that all the information stated above are true
and correct as to the best of my knowledge. I hereby give
consent for my personal data included in my offer to process for
the purpose of admission and enrolment in accordance with
Republic Act 10173 - Data Privacy Act of 2012
Signature over printed name
Republic of the Philippines
CAVITE STATE UNIVERSITY
CCAT Campus
Rosario, Cavite
(046) 437-9505 / 🖷 (046) 437-6659
cvsurosario@cvsu.edu.ph
www.cvsu-rosario.edu.ph
ADMISSION MONITORING SHEET (AMS)
1st Semester, Academic Year 2025 – 2026
Admission Control Number: 117806 Entrance Exam Number: ________________
NAME: JOSOL, DIANA JANE RODA
CATEGORY : K12 (SHS GRADUATE) SHS STRAND: HUMSS
PREFERRED COURSE: Bachelor of Secondary Education (BSE) - Mathematics
CONTACT INFORMATION: 09927214826 EMAIL: josoldianajane@gmail.com
NAME OF SCHOOL LAST ATTENDED: ________________________________________________________________________
LRN: 124955110020 YEAR GRADUATED: ___________ AVERAGE FROM PREVIOUS SCHOOL: _________________
FORMS/ DOCUMENTS/ MATERIALS PERSONS AUTHORIZED
STEP OFFICE ACTIVITY DATE ACCOMPLISHED REMARKS
INVOLVED SIGNATURE
Original Admission Form and
Photocopy of Grade 11 or 12
Submission of Report Card & Certificate of Admission
1 OSAS Requirements Enrollment (with Short White Folder & Officer
Admission Monitoring Sheet)
Schedule for Entrance AMS and Entrance Examination Admission Date: ________
2 OSAS Exam Permit Officer Time: ________
Venue: ________
Secure Notice of AMS and NOA Form Admission
3 OSAS Admission (NOA) NOA Control Number: Officer
______________________________
Secure Referral Slip for
4 CAMPUS Medical Examination Referral Slip Campus
CLINIC Nurse
5 CAMPUS Submit Medical Exam Medical Exam Result Campus
CLINIC Result Nurse
Secure Medical
6 CAMPUS Clearance (Fit to enroll) Medical Clearance Campus
CLINIC Nurse
ENROLLMENT Submit ORIGINAL DOCUMENTS
7 CAMPUS (Make sure that the (*Requirements)
REGISTRAR requirements are Please produce a photocopy of Registrar
complete before each Original Documents
ENROLLMENT)
*Requirements: (ORIGINAL DOCUMENTS will be submitted in step 7) *Please produce a photocopy of each Original Documents
New Entrants (SHS Graduate) Transferee ALS Passer 2nd Courser
-Admission Form -Admission Form -Admission Form -Admission Form
-Grade 12 Report Card (Original) -TOR/Evaluation of Grades -Certificate of Rating -TOR/Evaluation of Grades
-Good Moral Certificate (Original) -Certificate of Transfer/Honorable -Diploma -Certificate of Transfer/Honorable
-PSA/NSO (if available) Dismissal -Good Moral Certificate Dismissal
-3pcs. 1x1 pic -NBI/Police Clearance -PSA/NSO (if available) -Good Moral Certificate
-Short Brown Envelope -Good Moral Certificate -3pcs. 1x1 pic -PSA/NSO (if available)
-PSA/NSO (if available) -Short Brown Envelope -3pcs. 1x1 pic
-3pcs. 1x1 pic -Short Brown Envelope
-Short Brown Envelope
NOTE: Any deception, falsification, and dishonesty in the declaration of information and submitted requirements will mean non-evaluation of application.
Submit the accomplished AMS to the Office of Student Affairs and Services after Enrollment.
______________________________________
Student’s Signature over printed name
Reviewed and Evaluated by: Approved for Enrollment:
______________________________Date:_____ ________________________________Date:_____
Admission Officer Campus Registrar
