TO BE FILLED OUT ONLY BY THE ADMISSION APPLICATION NUMBER

OFFICER AND/ OR AUTHORIZED PERSONNEL

UNIVERSITY OF RIZAL SYSTEM TO RECEIVE AND/ OR PROCESS APPLICATION 2425A42466
Testing center:
Website: http://www.urs.edu.ph/ 1 URS Angono 4 URS Cainta 7 URS Pililla
2 URS Antipolo 5 URS Cardona 8 URS Rodriquez

URS APPLICATION FORM FOR 3 URS Binangonan 6 URS Morong 9

10
URS Tanay
URS Taytay
COLLEGE ADMISSION Documents/ Requirements Submitted
Form 138 Good moral Psa / birth Cbc
First Semester,SY 2024-2025 certificate certificate
TO THE STUDENT AND PARENTS: Chest x-ray Covid-19 Drug test Urinalysis
vaccination card
Carefully read the Instruction before filling out the application
form.
Print neatly all information required. Only accomplished L.R.N. 109336120264 Received by:
application forms, (URS College Admission Form) will be
processed.

1. NAME OF STUDENT-APPLICATION. Print of type your full name in the following sequence. LAST NAME, FIRST NAME, MIDDLE NAME. Place one letter in each box. Leave one
box between names.

Last D A M A L E R I O

First R E N A L Y N

Middle T A B E G U E

2. GENDER Male Female 3. RELIGION Roman Catholic

4. DATE OF BIRTH (Month/ Day/ Year) 08/03/2005 AGE 18 CIVIL STATUS Single

5. PLACE OF BIRTH (City/ Town, Province) LAJOG CLARIN BOHOL

6. CITIZENSHIP a. Filipino (If born abroad please submit a photocopy of a valid Philippine Passport or a BOI Identification Certificate)

b. Natural Born Filipino c. Foreign(Specify) c. Dual(Specify)

7. HIGH SCHOOL (Where you completed/ are completing secondary level education): INTERVIEW
Hign School Name Expected Month/ Academic
PAMANTASAN NG LINGSOD NG MARIKINA Visit the Office of the Dean for an
(Do not abbreviate) Year of Completion Strand/ Track
Interview. Do not submit the form if
Address 05/24/2024 STEM not undergone the process.

College of:

8. URS CAMPUS APPLIED FOR Education

Do not include the same campus twice. Write NONE on the blank if you do not have other choices of campus and course.
Engineering
URS CAMPUS INTENDED COURSE(See list of Undergraduate Degree Program) Science

1st choice ATO-BS CE Industrial

Antipolo Campus Technology
2 choice
nd
ATO-BSE MATH

1st choice CNA-BSE ENG Interview Rating

Cainta Campus
2 choice
nd
CNA-BT AT
Choose from among the following(two choices allowed)
1. URS Angono 3. URS Binangonan 5. URS Cardona 7. URS Pililla 9. URS Tanay General Name of Interviewer
2. URS Antipolo 4. URS Cainta 6. URS Morong 8. URS Rodriguez 10. URS Taytay Average Over Signature

9. ARE YOU A CHILD OF A URS FACULTY OR EMPLOYEE? Place an X in the appropriate box. No Yes
Name of Parent Employed by URS Official Designation
College/ Office where employed Telephone No.
10. Do you belong to Indigeneous Communities 12. Are you an anthlete? No Yes 13. Are you the first to enter college among your siblings? No Yes

(ICs)/Indigeneous People(IPs)? No Yes If yes, in what event?

If no, write the name of your siblings raquel tabegue damalerio
11. Do you belong to Persons with Regional National International
and his/her position Middle
Disability/s? No Yes
14. PERMANENT ADDRESS 15. ARE YOU SELF-SUPPORTING?

Number & Street Block 6 lot 15 fj berwanger st peace village phase 1

No Yes If Yes, nature of work (put an X to appropriate work)
Sybd/ Village/ Brgy SAN LUIS
Food Chain Crew Gasoline Boy/ Girl
City/ Town & Province ANTIPOLO,Rizal
Vendor Messenger
Postal Code 1870 Telephone 0000000
Household Construction
Email Address [email protected]
Others (please specify)
Facebook Account https://www.facebook.com/renalyn.damalerio

16. SOCIO ECONOMIC Furnish all the required information on each family listed. Write DECEASED after name of deceased family members. Under the Column "Highest Educational Attainment", indicate the
educational level which the household member actually completed. (i.e. Grade II, Third Year HighSchool, High School Graduate,Second Year College, College, BSE or Ph. D., Ed. D.)
NAME CITIZENSHIP MARITAL STATUS HIGHEST PRESENT MONTHLY
EDUCATION OCCUPATION INCOME
ATTAINMENT (In Phil. Pesos)

Father Raul Carpentero Damalerio Filipino Married High School tricycle driver 12000.00

Mother Ramonita Mulato Tabegue Filipino Married High School housewife 0.00

Legal Guardian Ramonita Mulato Tabegue Filipino 0.00

This is to certify that all information given above is true and correct.
RENALYN TABEGUE DAMALERIO
Signature over Printed Name of Applicant

THIS FORM IS FREE OF CHARGE AND MAY BE PHOTOCOPIED

URS-AA-SS-ADM-F-2017-01 Rev 01 Nov. 15, 2018