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GUIDANCE CENTER
Tel. No. (053) 555 - 8458
APPLICATION FORM
COLLEGE ENTRANCE EXAMINATION 2x2 colored ID Picture with
SY __2019-2020__ nametag
(Lastname, Firstname,
Middlename)
BACKGROUND INFORMATION
Contact Information
Permanent Home Address: BARANGAY DISTRICT 26 ISLA VERDE ORMOC CITY LEYTE Zip Code: 6541
House No., Street, Barangay City/Municipality Province
Telephone/Cell phone No.: 09075566865 Email Address (if available): WWW.W.ROLDEN@YAHOO.COM
SCHOOL ATTENDED (Where you last attended/are currently completing secondary level education)
Name of School: ST. ALOYSIUS INSTITUTE OF TECHNOLOGY
http://application.pit.edu.ph/print_application.php?rel=20181561015781846 1/3
6/20/2019 PIT | Application Form
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 disquali cation 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 a rm my right to be informed, object to processing, access and rectify, suspend or withdraw my personal data, and be
indemni ed 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
PIT Vision:
A Premier Polytechnic State University
PIT Mission:
To strengthens its capacity of producing higly skilled, competent, and world-class human resources, responsible to ful ll 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.
http://application.pit.edu.ph/print_application.php?rel=20181561015781846 2/3
6/20/2019 PIT | Application Form
GUIDANCE CENTER
Tel. No. (053) 555 - 8458
Examination Permit
NOTE:
1. Present this exam permit to the examiner before taking the exam.
2. Please be at the testing site 30 min. before the exam starts.
3. Examinees without exam permits are not allowed to take the test.
4. Late examinees are not allowed to take the test.
5. Please bring black ballpen and pencil (preferably no. 2).
6. Bring your snacks ( if desired). No one is allowed to leave the room until CHERRIE RED L. ABILAR
testing is over.
OIC - Guidance Coordinator
GUIDANCE CENTER
Tel. No. (053) 555 - 8458
Examination Permit
NOTE:
1. Present this exam permit to the examiner before taking the exam.
2. Please be at the testing site 30 min. before the exam starts.
3. Examinees without exam permits are not allowed to take the test.
4. Late examinees are not allowed to take the test.
5. Please bring black ballpen and pencil (preferably no. 2).
6. Bring your snacks ( if desired). No one is allowed to leave the room until CHERRIE RED L. ABILAR
testing is over.
OIC - Guidance Coordinator
http://application.pit.edu.ph/print_application.php?rel=20181561015781846 3/3