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Registration Form

This document is a registration form for a semester at a university that collects personal and academic information from the student. It requests information such as name, address, date of birth, religion, emergency contact, previous schools attended and degrees earned. It also includes a student pledge to abide by university rules. The second part is for registrar use and lists admission requirements including documents needed based on student type such as senior high graduate, foreign student, or alternative learning system passer. It indicates if a student is admitted and notes any incomplete requirements.

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Mecaella Natividad
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© © All Rights Reserved
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Download as PDF, TXT or read online on Scribd
48 views

Registration Form

This document is a registration form for a semester at a university that collects personal and academic information from the student. It requests information such as name, address, date of birth, religion, emergency contact, previous schools attended and degrees earned. It also includes a student pledge to abide by university rules. The second part is for registrar use and lists admission requirements including documents needed based on student type such as senior high graduate, foreign student, or alternative learning system passer. It indicates if a student is admitted and notes any incomplete requirements.

Uploaded by

Mecaella Natividad
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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REGISTRATION FORM

________Semester, SY 20___-20___

__ NEW Student __ OLD Student

A. PERSONAL RECORDS ID No.: _________________ LRN: ____________________

Name (Print): ______________________________________________________________________


(Family Name) (Given Name) (Middle Name)

Address: __________________________________________________________________________
(Barangay) (Town/City) (Province)
Program: ___________________________________ Major: ________________Curr. Year:______
Date of Birth: _______________________________ Gender at Birth: ( ) Male ( ) Female
(MM/DD/Year)
Place of Birth: _____________________________________ Contact No.: ____________________
(Town/City, Province)
Religion:_______________________________________

Person to notify in case of emergency:


Name: ____________________________________________ Contact No.: ____________________
Address: __________________________________________________________________________

B. ACADEMIC RECORDS

YEAR
NAME OF SCHOOL PROGRAM
GRADUATED
Senior High School

Transferee

Vocational

Degree(if graduated)

C. STUDENT PLEDGE: In consideration of my admission to the Don Mariano Marcos Memorial


State University, I hereby promise and pledge to abide by and comply with the rules and
regulations laid down by duly constituted authority. I hereby certify on my honor to the
correctness of the foregoing data about myself.

Date of Registration: _________________________ _____________________


Student’s Signature

DMMMSU-SAR-F003
Rev. No. 01 (10-26-2020)
--------------------------Below this line is for the Registrar/Staff to fill out-----------------------------

D. REQUIREMENTS FOR ADMISSION:

____Senior High School Graduate ____Foreign Student


( ) Enrollment Permit signed by the Coll. ( ) Enrollment Permit signed by the Coll.
Dean/Inst. Dir./Prog. Chair & Medical Dean/Inst. Dir./Prog. Chair & Medical
Officer Officer
( ) CAT Result ( ) CAT Result
( ) Registration Form ( ) Registration Form
( ) Senior High School Card/SF-9 ( ) Letter of Intent
( ) Cert. of Good Moral Character ( ) Cert. of Completion of a Secondary Curr.
( ) Birth Certificate from PSA ( ) Original Transcript of Records
( ) Applicant’s Photo-2”x 2” w/ nametag ( ) CHED Permit
( ) Personal Data
( ) Affidavit of Support
____College Graduate/Transferee ( ) Alien Cert. of Registration
( ) Enrollment Permit signed by the Coll. ( ) Alien Fee
Dean/Inst. Dir./Prog. Chair & Medical ( ) Result of TOEFL/IELTS (for non native
Officer speakers of English
( ) Registration Form ( ) Student Visa
( ) Cert. of Transfer Credential ( ) Security Clearance from his Embassy
/Honorable Dismissal ( ) Resident Guarantor of his character
( ) Certified True Copy of Grades ( ) Applicant’s Photo-2”x 2” w/ nametag
( ) Cert. of Good Moral Character
( ) Birth Certificate from PSA
( ) Applicant’s Photo-2”x 2” w/ nametag

____Alternative Learning System Passer


( ) Enrollment Permit signed by the Coll.
Dean/Inst. Dir./Prog. Chair & Medical Officer
( ) CAT Result
( ) Registration Form
( ) ALS Rating
( ) Certified True Copy of List of Passer
( ) Birth Certificate from PSA
( ) Applicant’s Photo-2”x 2” w/ nametag

Remarks: ______ Admitted; has submitted complete requirements.


______Temporarily Admitted due to incomplete requirements; submission of lacking
requirements as promised will be on or before _____________________________.

___________________________
Campus Registrar/Staff

___________________________
Date
DMMMSU-SAR-F003
Rev. No. 01 (10-26-2020)

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