RIZAL TECHNOLOGICAL UNIVERSITY
Cities of Mandaluyong and Pasig
Please attach your
2x2 ID picture here
APPLICANT ADMISSION SLIP
(Please print in CAPITAL LETTERS) PERSONAL DATA SHEET
PRIORITY NUMBER: INTENDED COURSE:
FRESHMAN TRANSFEREE LIFE LONG LEARNER SECOND COURSER
FULL NAME: SURNAME FIRST NAME MIDDLE NAME
PRESENT ADDRESS:
SEX: DATE OF BIRTH: PLACE OF BIRTH:
MALE FEMALE
RELIGION: NATIONALITY:
LANDLINE NUMBER: MOBILE NUMBER: EMAIL ADDRESS:
NAME OF SCHOOL ATTENDED:
SENIOR HIGH SCHOOL JUNIOR HIGH SCHOOL
LEARNER’S REFERENCE NUMBER:
I hereby affirm that all information supplied herein are complete and accurate. I acknowledge that withholding or giving
false information will result in my ineligibility for admission, or immediate dismissal. If duly admitted, I agree to abide by all the
policies, rules, and regulations of Rizal Technological University.
__________________________________________
Signature over printed name
1. INTERVIEW 2. INDIVIDUAL INVENTORY FORM
ADMITTED
(to be filled out by DH): If the applicant passed the interview, please write his/her designated Individual Inventory Form submitted
block section below.
____________________
BLOCK SECTION: ___________________________
Date
NOT ADMITTED
Note: If admitted, please proceed to CASU Office, located at Old Building 2nd Floor Note: Please proceed to SRAU Office, located at Main Academic Building (MAB) GF
(Student Center Office) to fill-out the Individual Inventory Form. to submit your requirements.
______________________________________ _______________ _______________________________________ _______________
DEPARTMENT HEAD Date Signed CASU PERSONNEL Date Signed
(Signature over printed name) (Signature over printed name)
3. STUDENT RECORDS AND ADMISSION UNIT 4. PHYSICAL/MEDICAL EXAM
Submitted the following: ADMITTED NOT ADMITTED
☐ Original F138 / report card ☐ Honorable Dismissal ☐ True copy of Grades
Submitted all requirements Date__________________
☐ Good Moral Certificate ☐ photocopy of PSA-issued ☐ 2 pcs. 2x2 ID picture with
birth certificate nametag and signature Lacks ______________________________________
Note: After the submission of requirements, proceed to NSTP Office, located at Old Building GF to get the NSTP Subject to be submitted on or before _______________________
Code before you enroll your other subjects this semester.
______________________________________ _______________ ____________________________ ___________
ADMISSION/ SRAU PERSONNEL Date Signed MEDICAL/ DENTAL PERSONNEL Date Signed
(Signature over printed name) (Signature over printed name)
1. The period of withdrawal of credentials submitted will start on the 1st week of classes, with a withdrawal fee of Php 1,000.00 until the last day of system dropping
period. The student may request for transfer credentials during normal dropping period if they intend to enroll in other school/university.
2. Admitted applicants may submit their Form 137 (or Transcript of Records for transferees together with the accomplished Accreditation Form) within 60 calendar
days after the 1st day of school commenced.
By signing this form, I confirm that I acknowledge, agree, and shall comply with the abovementioned requirements and processes.
_______________________________________________ ________________
Signature over printed name Date signed
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RIZAL TECHNOLOGICAL UNIVERSITY
Cities of Mandaluyong and Pasig
RECOMMENDATION FOR THE INTERVIEW IN ANOTHER COURSE
SECOND COURSE
If the applicant does not meet the requirements of the intended ADMITTED NOT ADMITTED
course, please proceed to the Department of ___________________
and look for _______________________________.
________________________________ ____________
DEPARTMENT HEAD Date Signed
(Signature over printed name)
THIRD COURSE
If the applicant does not meet the requirements of the intended ADMITTED NOT ADMITTED
course, please proceed to the Department of ___________________
and look for _______________________________.
________________________________ ____________
DEPARTMENT HEAD Date Signed
(Signature over printed name)
CUT THIS PORTION
PLEASE PRESENT THIS DURING ENROLLMENT
PRIORITY NUMBER: COURSE:
FRESHMAN TRANSFEREE LIFE LONG LEARNER SECOND COURSER
FULL NAME: SURNAME FIRST NAME MIDDLE NAME
STUDENT RECORDS AND ADMISSION UNIT
Submitted the following:
☐ Original F138 / report card ☐ Honorable Dismissal ☐ True copy of Grades
☐ Good Moral Certificate ☐ photocopy of PSA-issued birth certificate ☐ 2 pcs. 2x2 ID picture with nametag and signature
______________________________________ _______________
ADMISSION/ SRAU PERSONNEL Date Signed
(Signature over printed name)
1. The period of withdrawal of credentials submitted will start on the 1st week of classes, with a withdrawal fee of Php 1,000.00 until the last day of system
dropping period. The student may request for transfer credentials during normal dropping period if they intend to enroll in other school/university.
2. Admitted applicants may submit their Form 137 (or Transcript of Records for transferees together with the accomplished Accreditation Form) within 60
calendar days after the 1st day of school commenced.
By signing this form, I confirm that I acknowledge, agree, and shall comply with the abovementioned requirements and processes.
_______________________________________________ ________________
Signature over printed name Date signed
Page 2 of 2
