Undergraduate Online Enrollment Form

Admissions

Undergraduate Online Enrollment Form

You may also download and fax the completed form to 715-0849. Download in MSWord or PDF format.

A. PERSONAL CIRCUMSTANCES

Full Name:

Date of Birth:

Place of Birth:

Present Address:

Telephone Number:

Mobile Number:

Email Address:

Sex:

Civil Status:

Citizenship:

Guardian/Parents:

Present Address:

B. SCHOOLS ATTENDED

High School: (Please indicate institution name, address, years of attendance and honors received)

College: (Please indicate institution name, address, years of attendance and honors received)

C. CREDENTIALS SUBMITTED HEREWITH (Please check all applicable)

Cert. Of Transfer Credentials

Cert. Of Good Moral

Cert. Of Scholarship

Cert. Of Grades for last Semester of attendance (Transferees)

H.S. Report Card (F138)

D. COURSE APPLIED FOR

Arts & Sciences

Business Administration

BS Computer Science

Architecture

Secretarial

Accountancy

Engineering

Education

Graduate Course

BS Nursing

Optometry

E. EMPLOYMENT HISTORY

Please indicate employer name, address and years employed

F. SECTION & SESSION PREFERRED (For freshmen Block Section Only)

Morning

Afternoon

Evening

Adviser Code:

G. FRATERNITIES/SORORITIES/CIVIC ORGANIZATIONS AFFILIATED

Please indicate organization name, address, years of affiliation and purpose of organization

H. SCHOLARSHIP

HR Reyes Scholar

Entrance Scholar

Other, please specify:

I. Have you ever been accused/convicted of a criminal offense?

Yes

If yes, please state full particulars

In submitting this form, be it known that I, the undersigned, have seen all the school facilities (libraries, laboratories, classrooms, comfort rooms, etc.). I have read the financial requirements for enrollment and I acknowledge that I have read the school’s amended Rules and Regulations. I am satisfied with the school facilities. I find the tuition fee and other fees acceptable and I hereby agree to abide by the condition set forth in the amended Rules and Regulations promulgated by the CCP and by the other rules and regulations, which may be issued from time to time. I agree to pay for whatever increases in tuition and other miscellaneous fees, which may be permitted by the Commission on Higher Education for the incoming school year.

Name of Parent/Guardian:

In submitting this form, be it known that I, parent/guardian of the applicant enrollee, do hereby agree to any increase in tuition, miscellaneous, and other fees which may be imposed by the school.