CUTARAN G10 Enrolment Form

Republic of the Philippines PRIVACY NOTICE
CMU is committed in complying the mandates of National

CENTRAL MINDANAO UNIVERSITY Privacy Commission and implementing the Rules and
Musuan, Maramag, Bukidnon Regulations of Data Privacy Act of 2012. Personal information
being collected through this enrolment form will be used for
educational purposes and will be kept for record purposes only.
CMU LABORATORY HIGH SCHOOL
CMULHS FORM No. I-A1 Enrolment Form
I.D. Number 2020000264 LRN: 405061150158 Date of Enrolment:
CUTARAN LOREEN CARELL TUANA GERIGDIG

Name: ________________________________________________________________________
Surname First Name Ext (Jr, I, II) Middle Name
Grade Level: TEN Section: School Year: 2023-2024
Subject Descriptive Title Unit Day Time

A Back/Advance Subjects
1.
B Regular Subjects
1. Sci 10 Integrated Science 4 2
2. Math 10 Mathematics 4 1
3. Fil 10 Sining ng Komunikasyon at Panitikan 4 1
4. Engl 10 Communication Arts and Literature 4 1
5. Soc Stud 10 Social Studies 4 1
6. Sci 10a Organic Reactions 1
7. Math 10a Introduction to Calculus 1
8. Sci Res 2 Science Research 2 1
9. TLE 10 Technology and Livelihood Education 4 1
10. MAPEH 10 Music, Arts, P.E., Health & Scouting 4 1
11. Val Ed 10 Values Education/GMRC 4 1
TOTAL 12
Miscellaneous Fees Amount

1. Development Fee* ₱350.00*
2. Athletic Fee* 150.00* Signature Remarks
3. Graduation Fee* 280.00*
4. Laboratory Fee* 300.00* ID Taken
5. School Organ* 65.00* PRIO
6. ID*** 100.00*
Sub Total ₱1,245.00* Checked by
7. BSP/GSP/Red Cross 15.00
8. Club Fee 30.00 Collected by
9. Insurance 35.00
10. Student Activity Fee (ULHSSCO) 250.00 Audited by
Sub Total ₱330.00
11. Facilities Maintenance 50.00
12. Test Paper Fee 250.00
13. PTA Membership Fee 1,500.00 O.R. No.
14. Additional Completion Fee 400.00
Sub Total ₱2,200.00
TOTAL ₱3,775.00
This is to certify that the above-named student is officially enrolled in this University. He/She
may be admitted to his/her classes.
JOEMAR
DENIS B. CAPUYAN
A. TAN, Ph.D.
________________________
Chairman, Enrolment Committee
*Official Receipt from University Cashier

***ID is optional for old/continuing students with valid CMULHS ID
CMU-F-1-ULH-004c 18 July 2022 Rev.0 Page 1 of 2

(Print all Entries)
PERSONAL DATA SHEET
Name: CUTARAN LOREEN CARELL GERIGDIG

__________________________________________________________________________________
Surname First Name Ext. Name (Jr., II, III, IV) Middle Name
Sex: Female Civil Status: SINGLE Nationality: FILIPINO Religion: ROMAN CATHOLIC
Date of Birth: MAY 25, 2008 Age of last birthday: 15 Birthplace: MARAMAG, BUKIDNON
Home Address: PUROK 11 SINAYAWAN VALENCIA CITY BUKIDNON

(Street/Zone/Purok) (Barangay) (Municipality/City) (Province)
Campus Address (for non-commuter only):
No. of Children in the family: 3 Rank from the eldest: 2nd Dialect(s) spoken at home: BISAYAN
Special Talents: Hobbies:
School last attended: CMU LABORATORY HIGH SCHOOL School Type: STATE UNIVERSITY
Address of school last attended: UNIVERSITY TOWN, MUSUAN, MARAMAG, BUKIDNON
Parents’ Name Highest Educational

(Surname, Given Name & Middle Name) Occupation Attainment Income/Month
Father: CUTARAN, RENELO, MAIQUE FARMER COLLAGE GRADUATE
Mother: GERIGDIG, ELLEN ANN, BOLNEO GOVERNMENT EMPLOYEE MASTER'S DEGREE

Mother’s Maiden Name
Total Family Income per month
In case of emergency, please contact:
Name: ELLEN ANN G. CUTARAN Relation to student: MOTHER
Address: PUROK 11 SINAYAWAN, VALENCIA CITY, Phone No. 09267328977
Do you suffer from any congenital /recurring illness? (Yes) (No) ✔
If yes, specify the illness ______________________________________________________________
Do you suffer from any disability? (Yes) (No) ✔
If yes, specify the disability_____________________________________________________________

(Be sure your illness/disability is reflected in your Physical Health Form)
I hereby certify under the pain of perjury that all my statements above are true and correct to the best of my
knowledge.
I have been informed that failure to submit the documents or fulfill the requirements may result in the cancellation
of my enrolment. I understand that the credentials that I submit become the property of Central Mindanao University
Laboratory High School and it will not be returned to me.
09533081907
Signature of Student Date Cel. Phone No.
STUDENT’S PLEDGE
For my admission to the Central Mindanao University, I hereby promise and pledge to abide by and comply with all
its rules and regulations.
Signature of Student
RENELO M. CUTARAN ELLEN ANN G. CUTARAN

Father’s Signature over Printed Name Mother’s Signature over Printed Name
Cel. Phone No. 09353902563 Cel. Phone No. 09267328977
Witnessed by:
Guidance In-Charge/Section Adviser’s Signature over Printed Name
CMU-F-1-ULH-004c 18 July 2022 Rev.0 Page 2 of 2

CUTARAN G10 Enrolment Form

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CUTARAN G10 Enrolment Form

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Republic of the Philippines PRIVACY NOTICE

CMU is committed in complying the mandates of National

CMU LABORATORY HIGH SCHOOL

CMULHS FORM No. I-A1 Enrolment Form

I.D. Number 2020000264 LRN: 405061150158 Date of Enrolment:

CUTARAN LOREEN CARELL TUANA GERIGDIG

Grade Level: TEN Section: School Year: 2023-2024

Subject Descriptive Title Unit Day Time

Miscellaneous Fees Amount

*Official Receipt from University Cashier

CMU-F-1-ULH-004c 18 July 2022 Rev.0 Page 1 of 2

Name: CUTARAN LOREEN CARELL GERIGDIG

Home Address: PUROK 11 SINAYAWAN VALENCIA CITY BUKIDNON

Special Talents: Hobbies:

Address of school last attended: UNIVERSITY TOWN, MUSUAN, MARAMAG, BUKIDNON

Parents’ Name Highest Educational

Father: CUTARAN, RENELO, MAIQUE FARMER COLLAGE GRADUATE

Mother: GERIGDIG, ELLEN ANN, BOLNEO GOVERNMENT EMPLOYEE MASTER'S DEGREE

In case of emergency, please contact:

Name: ELLEN ANN G. CUTARAN Relation to student: MOTHER

Address: PUROK 11 SINAYAWAN, VALENCIA CITY, Phone No. 09267328977

Do you suffer from any congenital /recurring illness? (Yes) (No) ✔

If yes, specify the illness ______________________________________________________________

Do you suffer from any disability? (Yes) (No) ✔

If yes, specify the disability_____________________________________________________________

RENELO M. CUTARAN ELLEN ANN G. CUTARAN

Guidance In-Charge/Section Adviser’s Signature over Printed Name

CMU-F-1-ULH-004c 18 July 2022 Rev.0 Page 2 of 2

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