Republic of the Philippines

ROMBLON STATE UNIVERSITY

Odiongan, Romblon

The Dean
Attached 2” x 2” ID
College of Engineering and Technology Picture
This University (School uniform with name
Odiongan, Romblon tag and white background)

ATTENTION: The University Registrar

Sir:
I have the honor to apply for the eligibility for graduation in this university as I have satisfactorily
completed all the academic requirements leading to the degree of BACHELOR OF SCIENCE IN CIVIL
ENGINEERING as of ____________________________.

Very truly yours,

S1-14-01034 ANTONIO M. FABELLA JR. .

Student ID Number Printed Name and Signature

APPLICATION OF TITLE FOR EVALUATION AND DEGREE FOR GRADUATION

College of Engineering and Technology
Date of Graduation________________

NOTE: FILL THE BLANKS IN TYPEWRITTEN OR PRINT

A. Personal Data:
Name: FABELLA _ANTONIO, JR. MALHACAN .
(Family Name) (Christian Name) (Middle Name)
Age: 21 . Date of Birth: January 24, 1998 Place of Birth: Odiongan Gender: Male_
Home Address: House No. 188, Purok Sampaguita, Batiano, Odiongan, Romblon .
Parent or Guardian: Mercidita M. Fabella Address: Batiano, Odiongan, Romblon .

Name of School Attended School Term

Primary: Batiano Day Care Center__ 2000 to 2003
Intermediate: Odiongan North Central Elementary School 2003 to 2010
Secondary: RSU-Science High School 2010 to 2014
Collegiate: Romblon State University-Main Campus 2014 to 2019
Title of Degree applied for: Bachelor of Science in Civil Engineering .
Major: ________________________________ Minor: _______________________________

B. Curricular Data:
Number of units earned in major: ___________ Number of units earned in minor: _________

Credential entered: (Please Check)

Form 138 NSO birth Certificate
Form 137A Marriage License
ROSCAT Rating Honorable Dismissal
NROTC/CWTS Transcript of Records

Subject Taken with Deficiencies Rating/Remarks Term Taken Professor/Instructor

___________________________ _________________________ ________________________
___________________________ _________________________ ________________________
___________________________ _________________________ ________________________
___________________________ _________________________ ________________________
Subject loads and units taken by term:

Total Unit Load Term Taken School Year

First Year 27 Units First Semester 2014-2015 .

28 Units Second Semester 2014-2015 .
. . .

Second Year 28 Units First Semester 2015-2016 .

26 Units Second Semester 2015-2016 .
. . .

Third Year 24 Units First Semester 2016-2017 .

22 Units Second Semester 2016-2017
4 Units Summer 2016-2017 .

Fourth Year 25 Units First Semester 2017-2018 .

26 Units Second Semester 2017-2018 ..
6 Units Summer 2017-2018 .

Fifth Year 19 Units First Semester 2018-2019 .

11 Units Second Semester 2018-2019 .
. . .

Date Accomplished: February 1, 2019 .

Approved for evaluation purposes

ENGR. RAYMOND JAY G. SEVERO DR. BILSHAN F. SEVAÑEZ ALEJANDRO Q. MAULION_

Chairman/Adviser College Dean University Registrar

Not valid without the university dry seal