membership application - center for educational … · membership application school year 20___ -...
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Membership Application
School Year 20___ - ___
Application � New
� Renewal Last Registered SY 20____ - ____
Membership Category � Institutional
� Departmental
{ Elementary
{ Secondary (Grades 7 to 12) { Tertiary
____________________________(name of college)
Total No. of Students:
Name of School (Official Name)
Year Established Web Site Address
Address (No., Street, Barangay, Subdivision)
City Province Zip Code
Type of School: o Private Sectarian o Private Non-Sectarian o Public
Levels Offered: o Kindergarten o Junior High School o Tertiary o Others
o Elementary o Senior High School o Graduate ___________
School Head 1 (Last Name, First Name, M.I.) Designation Email
School Head 2 (Last Name, First Name, M.I.) Designation Email
School Associations Accreditations
� CEAP (Catholic Educational Association of the Philippines)
� PACU (Philippine Association of Colleges and Universities)
� PASUC (Philippine Association of State Universities and Colleges)
� ACSCU (Association of Christian Schools, Colleges and
Universities)
� PAPTI (Philippine Association of Private Technical Institutions)
� Others ____________________________
Accrediting Agency
� PAASCU (Philippine Accrediting Association of
Schools, Colleges and Universities)
� PACUCOA (Philippine Association of Colleges and
Universities Commission on Accreditation)
� ACSCU-AAI (Association of Christian Schools,
Colleges and Universities-Accrediting Agency, Inc.)
� Others ________________________
Level
____
____
____
____
CONTACT INFORMATION
Contact Person (Last Name, First Name, M.I.) Designation
Phone Fax
Mobile Email
Preferred Mode of Contact: o Phone o Fax o Mobile o Email
SCHOOL FINANCE/ACCOUNTING CONTACT PERSON (billing purposes):
Last Name, First Name, M.I. Designation Phone
PAYMENT (Annual membership is P2,000.00)
Payment option: � Check enclosed. Payable to Center for Educational Measurement, Inc. � Bank deposit. BPI Pasong Tamo La Fuerza Branch Acct. No. 1885-1133-34
(Send a copy of the validated deposit slip with school name and address to CEM Head Office by fax or email)
� Payment pick-up. - Metro Manila and nearby areas. Call CEM Finance Office at (02)813-3694 to 95 loc. 104 or 105.
Ask for Lovelyn Santibañez. - Others. Call branch manager or center coordinator (See back for contact details).
REMINDER1. Send your membership fee within 30 days
after filing this form.
Early payment ensures your school of discounted test fees and other benefits.
2. Please make a copy of this completed form for your records.
3. Membership certificate is given to schools that have availed of the CEM testing services AND paid membership dues.
Certificate will be mailed within 30 days after test administration.
(SEE BACK FOR CONTACT DETAILS)
BRANCH/CENTER USE ONLY
Date Received: ____ / ____ / ____
Payment: o Cash o Check
HEAD OFFICE USE ONLYCenter ________________________School Code ____________________ Membership ID No. ________________
Date Received: ____ / ____ / ____
Date Entered: ____ / ____ / ____
I certify that the information herein is true and correct.
_____________________________Authorized Representative
Signature Over Printed Name
_____________________________Date
CEM BRANCH & CENTER COORDINATORS
MS. MA. LOURDES M. FRANCOCEM CENTRAL OFFICE24th Cityland Pasong Tamo Tower2210 Chino Roces Ave., Makati CityTel. No. (02) 813-3691; 813-3694 to 95Fax No. (02) 894-1392; 894-5536
MS. KAREN LISETTE M. REYESMETRO MANILA8279 Camachile Street Cor. Mayapis Street San Antonio Village, Makati CityTel. No. (02) 804-2145; 858-4810Telefax No. (02) 895-8236Email: [email protected]
CEM LUZON CENTERS
MS. AGATHA BRENICA D. ILAGANCEM LUCENA CENTER111 Hasmin Street, Zaballero Subdivision4301 Lucena CityTelefax No. (042) 710-3342Cell No. 0922-8798271Email: [email protected]
MS. ROSALIA V. DELOS SANTOSCEM ISABELA CENTERUniversity of La SaletteDubinan East, Santiago City, 3311 IsabelaTel. No. (078) 682-4799; 682-8205Cell No. 0917-5981138Email: [email protected]
SR. ASCENCION L. DOMUGHO, O.P.CEM PUERTO PRINCESA CENTERHoly Trinity UniversityPuerto Princesa City, 5300 PalawanTel. No. (048) 433-2061 loc. 205Fax No. (048) 433-2161; 433-2061Cell No. 0998-2542986Email: [email protected]
MS. MA. LOURDES M. FRANCOCEM OLONGAPO CENTER(c/o CEM CENTRAL OFFICE)24th Flr. Cityland Pasong Tamo Tower2210 Chino Roces Ave., Makati CityTelefax No. (02) 813-3691; 813-3694 to 95Fax No. (02) 894-1392; 894-5536Email: [email protected]
REV. FR. REYNALDO B. JIMENEZ, SVDCEM LAOAG CENTERDivine Word College of LaoagLaoag City, 2900 Ilocos NorteTel. No. (077) 772-0736 loc. 113Telefax No. (077) 772-1625Cell No. 0921-2432440; 0926-4028503 (R. B. Pellogo)Email: [email protected]
MS. ERLINDA C. MONESCEM CABANATUAN CENTERWesleyan University-PhilippinesCabanatuan City, 3100 Nueva EcijaTel. No. (044) 463-2162; 463-2074Cell no. 0922-8594786Email: [email protected]
MS. SHIRLEY P. DIÑOCEM BAGUIO CENTERUniversity of BaguioGen. Luna Road, Baguio City, 2600 BenguetTel. No. (074) 442-4915 loc 233Fax No. (074) 442-3071Cell No. 0907-2088942Email: [email protected]
MR. NOEL S. SINOGBACEM NAGA CENTER538 Diamond Street, Filoville Subd.,Naga City 4400 Camarines SurTel. No. (054) 205-0409Cell No. 0929-5192118Email: [email protected]
MS. GJENILYNNE M. CALIMAGCEM TUGUEGARAO CENTER#53 Balzain Highway,Tuguegarao City 3500 CagayanCell No. 0917-6228402Email: [email protected]
CEM VISAYAS BRANCH & CENTERS
MS. MUSSOLINI S. YAPCEM CEBU BRANCHSuite 104 Arbor Ville308-A Osmeña Blvd., 6000 Cebu CityTelefax No. (032) 256-3082Cell No. 0917-5553541Email: [email protected] [email protected]
MS. TERESITA G. MAGHANOYCEM BOHOL CENTERSta. Filomena, Alburquerque6302 BoholCell No. 0918-6882179Email: [email protected]
MS. CINDERELLA R. FRANCISCOCEM BACOLOD CENTERUniversity of St. La SalleLa Salle Avenue, Bacolod City6100 Negros OccidentalTelefax No. (034) 433-2175; 432-1182 loc 136/173Cell No. 0932-4817044Email: [email protected]
MS. MELBA M. NAVARRACEM LEYTE CENTERCogon, Palo, 6501 LeyteTel. No. (053) 321-2745Res. No. (053) 323-3985Cell No. 0999-9492923Email: [email protected]
c/o MS. MARIA CRISTINA D. ONGCEM ILOILO CENTERNo. 3 Solis Street, 5000 Iloilo CityTel. No. (033) 337-3143; 321-1000Cell No. 0917-3323227Email: [email protected]
MS. VIOLETA H. TEVESCEM DUMAGUETE-SU CENTERSiliman UniversityHibbard Avenue, Dumaguete City6200 Negros OrientalTelefax No. (035) 422-6002Email: [email protected]
CEM MINDANAO BRANCH & CENTERS
MS. LEA F. ELIVERACEM DAVAO BRANCHDoor 11, 2nd Flr. C. Villa Abrille & Sons Business CenterJ.P. Laurel Avenue, Davao City8000 Davao del SurTelefax No. (082) 226-4990Cell No. 0949-8393591Email: [email protected] [email protected]
DR. ALMA S. HORDISTACEM SOUTH COTABATO CENTER 028 Block 6 Dadiangas Heights, General Santos City9500 South CotabatoCell No. 0917-5410742; 0932-9812363Email: [email protected]
DR. TERESITA R. CABANIALCEM NORTH COTABATO CENTER1413 Blk. I, Villanueva Subdivision Kabacan, 9407 CotabatoTelefax No. (064) 572-2037Cell No. 0919-8429112; 0933-4686725Email: [email protected] [email protected]
MS. NORMA A. BALUCAATENEO DE ZAMBOANGA UNIVERSITY CENTERLa Purisima Street, Zamboanga City, 7000Tel. No. (062) 991-0871 loc 2223Fax No. (062) 991-0870Cell No. 0917-7079418Email: [email protected]
REV. FR. CHITO G. BUTARDOCEM BUTUAN CENTERFather Saturnino Urios UniversityCB Building, Main Campus, San Francisco Street,Butuan City 8600 Agusan del NorteTel No. (085) 342-1830 loc. 2112; (085) 341-6933Cell No. 0922-8026401; 0998-9954047Email: [email protected] [email protected]
MS. FLORDELIZA A. VELEZCEM CAGAYAN DE ORO CENTERDoor 2C, A&M BuildingTomas Saco-1st Street, NazarethCagayan de Oro CityTel No. (088) 881-0022Cell No. 0917-7950325Email: [email protected]