ILOILO DOCTORS' COLLEGE FORMS-AMS-001

REV # 2-JANUARY 06,2017

OFFICE OF ADMISSION
West Avenue, Molo, Iloilo City 500
Tel. No.: (033) 337-0034
APPLICATION FOR ADMISSION
O.R. No.: 2X2 SIZE
COLORED PICTURE
Amount Paid: Date of Application: ________________________
PRINT OR TYPE ALL INFORMATION.
SUBMIT THIS FORM TOGETHER WITH OTHER REQUIREMENTS.
UPON COMPLIANCE, YOUR ENTRANCE EXAMINATION WILL BE SCHEDULED.

APPLICATION IS MADE AS A:
FRESHMEN SHIFTER (STUDENT ENROLLED IN IDC DURING THE PREVIOUS SEMESTER)
SECOND COURSER (GRADUATE OF OTHER COURSE) TRANSFEREE (UNDERGRADUATE FROM OTHER SCHOOLS)

PERSONAL DATA ENROLLMENT INFORMATION

ID No.: Academic Year (AY): 20_____ - 20_____
NAME: 1st Sem. 2nd Sem. Summer
Last Name First Name Middle Name Auxiliary Name (Jr., Sr.,)
CHECK THE DEGREE PROGRAM YOU WISH TO
Any other name(s) used on transcripts and other documents: PURSUE
Citizenship: Gender: M F DOCTOR OF DENTAL MEDICINE
Civil Status: S M W BS PHYSICAL THERAPY
Permanent Mailing Address: BS SOCIAL WORK
Contact No.: Email Address: BS PSYCHOLOGY
Place of Birth: Date of Birth: BS BIOLOGICAL SCIENCE
Religion: Age: BSBA Major in Human Resource Management
BSBA Major in Financial Management
Parent/Guardian: BS COMPUTER SCIENCE
Relation to Applicant: Contact No.: BS INFORMATION TECHNOLOGY
Address: BS INFORMATION SYSTEM
DIPLOMA IN MIDWIFERY
If Married: BS MIDWIFERY
Name of Spouse: Citizenship: ASSOCIATE IN RADIOLOGIC TECHNOLOGY
Contact No.: No. of Children: BS RADIOLOGIC TECHNOLOGY
BS NURSING
CERT. IN HEALTH CARE SERVICES
BS CRIMINOLOGY
BS MEDICAL LABORATORY SCIENCE

EDUCATIONAL BACKGROUND

Name of School Year Attended

Primary (Grades 1-4)
Intermediate (Grades 5-6)
Junior High School (Grades 7-10)
College

Are you coming in as a Scholar? YES NO

If YES check appropriate sponsoring agency:
CHE TESDA ILOILO CITY SCHOLAR OTHERS (Pls. specify)___________________________________
D
Are you interested in applying for any of the IDC Scholarship Programs? YES NO
If YES, Please check the scholarsip that you are applying:
Entrance Scholarship AFP Educational Benefit System Working Student
Athletic Scholarship
Volleyball Basketball Karatedo
Table Tennis Badminton

Have you ever applied to this College? YES NO If YES, When? Sem. Yr. _________
Have you ever attended this College? YES NO If YES, When? Sem. Yr. _________
Honors/Awards/Distinctions Received:
Temporary Enrollment Waiver Issued by: ____________________________________ Date: ________________________________
 PERSONAL DATA SHEET

NAME:
Last Name First Name Middle Name Auxiliary Name (Jr., Sr.,)

Citizenship: Gender: M F
Civil Status: Single Married Widow Separated Age:
City Address: Postal Code:
Contact No.: Religion:_______________________ Email Address:
Home Address: Postal Code:
Place of Birth: Date of Birth:
If Alien, ACR # (See Registrar):
Are you currently employed? YES NO If YES: Office/Bus. Tel. #:____________________
Status of Employment: Part-Time Full-Time
Employer:
Address: Contact Num.:
Father's Information Mother's Information
Last Name: Last Name:
First Name: First Name:
Middle Name: Middle Name:
Occupation/Employment:____________________________________ Occupation/Employment:
Educational Attainment:______________________________________ Educational Attainment:
Address: Address:
Contact Num.: Contact Num.:

Brothers and Sisters (Please list from Eldest to Youngest)

Name Employment Status Age Civil Status Address & Contact Num.

I certify that the information given herein is correct and complete. Falsification or withholding of information on this form
will automatically nullify my application and/or subject me to dismissal from the College.

Student's Signature over Printed Name Date Signed

YOUR APPLICATION IS VALID ONLY FOR THE SEMESTER STATED AT THE FRONT PORTION OF THIS FORM

Pre-Admission Requirements Submitted: ASSESSMENT OF GRADES

High School Graduate (For Academic Department Use Only)

____ HS Card Name of Student:

____ Cert. of GMC Advised to Enroll
____ Birth Certificate A.Y. 20___ - 20___
1st sem. 2nd sem. Summer
Transferees/Second Courser Curriculum Status:
____ TOR 1st Year 4th Year Regular
____ Cert. of Transfer Credentials 2nd Year 5th Year Irregular
____ Cert of GMC 3rd Year 6th Year
____ Birth Certificate Remarks:
____ Assessment of Grades by IDC Registrar
____ Marriage Cert. (for female applicants only)
HS Gen Average:________________________ Dean/Assessment Officer
Entrance Exam Result:
English: _______ /100 ENROLLMENT CLEARANCE:
Math: _______ /30 Course: ___________________
Name of Examiner & Signature: Approved for Enrollment: FRANCIS D. LAUREA
Director of Admission
FORMS-AMS-001
REV # 2-JANUARY 06,2017
Y 06,2017