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    2 X 2 Colored Picture: Registration Form

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    momo connor
    This document is a registration form for Central Luzon Doctors' Hospital Educational Institution. It collects student information such as name, date of birth, contact details, parents'/guardians' information, siblings enrolled at the school, last grade and school attended, course applying for, and signature of the student and parent/guardian. It also includes spaces for entrance exam results, interview remarks, medical exam results, and signatures of the psychometrician and dean.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    2 X 2 Colored Picture: Registration Form

    Uploaded by

    momo connor
    35 views1 page
    This document is a registration form for Central Luzon Doctors' Hospital Educational Institution. It collects student information such as name, date of birth, contact details, parents'/guardians' information, siblings enrolled at the school, last grade and school attended, course applying for, and signature of the student and parent/guardian. It also includes spaces for entrance exam results, interview remarks, medical exam results, and signatures of the psychometrician and dean.

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    This document is a registration form for Central Luzon Doctors' Hospital Educational Institution. It collects student information such as name, date of birth, contact details, parents'/guardians' information, siblings enrolled at the school, last grade and school attended, course applying for, and signature of the student and parent/guardian. It also includes spaces for entrance exam results, interview remarks, medical exam results, and signatures of the psychometrician and dean.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    35 views1 page

    2 X 2 Colored Picture: Registration Form

    Uploaded by

    momo connor
    This document is a registration form for Central Luzon Doctors' Hospital Educational Institution. It collects student information such as name, date of birth, contact details, parents'/guardians' information, siblings enrolled at the school, last grade and school attended, course applying for, and signature of the student and parent/guardian. It also includes spaces for entrance exam results, interview remarks, medical exam results, and signatures of the psychometrician and dean.

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    Registrar Form No.

    0008-2019
    2x2
    CENTRAL LUZON DOCTORS’ HOSPITAL EDUCATIONAL INSTITUTION
     (045) 982-5019 loc. 249  www.cldhei.edu.ph; Romulo Highway, San Pablo, Tarlac City
    REGISTRATION FORM Colored
    TERTIARY
    PLEASE PRINT CLEARLY AND COMPLETE ALL SECTIONS OF THIS FORM Picture

    School Year: Course Applying for: __________ Student # (for old student):__________

    Semester: [ ]1st Sem. [ ]2nd Sem. Last Grade Level Completed ________________ [ ] Transferee
    Last School Year Completed ________________ School Last Attended: _______________________________________

    STUDENT INFORMATION
    Name: _____________________________________________________________ Age: ________ Gender: _______
    Family name First Name Middle Name

    Date of Birth: ______________ Place of Birth: _______________ Religion: _____________ Nationality: ______________
    Contact No./s: Mobile: _____________________ Landline: ________________ Email: ___________________________
    Home Address: ____________________________________________________________________________________
    Siblings at CLDHEI: Grade/Year:
    ______________________________________ _________________________________ ____________________________
    ______________________________________ _________________________________ ____________________________

    PARENT’S/GUARDIAN’S INFORMATION
    Father Mother Guardian

    Name: (Last, First, middle) __________________________ __________________________ _________________________


    Contact No.: __________________________ __________________________ __________________________
    Email Address: __________________________ __________________________ __________________________
    Occupation: __________________________ __________________________ __________________________
    Name of Company: __________________________ __________________________ __________________________
    Company Address: __________________________ __________________________ __________________________
    __________________ _______________________________
    Date Student’s Signature Over Printed Name

    I hereby certify that the above information given are true and correct to the best of my knowledge and I allow CLDHEI to use my
    son/daughter details to create and/or upgrade student profile in the School Information System. The information herein shall be treated
    as confidential in compliance with the Data Privacy Act of 2012.
    O.R. #: ____________ (to be accomplish by registrar)
    _____________________________________
    Parent’s / Guardian Signature Over Printed

    Student’s Copy

    Date of exam: _______________ O.R. #: ___________ Course Applying for: _________________ Age: _______ Gender: _________

    Name: _________________________________________________ Date of Birth: _______________ Place of Birth: ______________


    Family name First Name Middle Name

    Contact No./s: ________________________ Email: __________________ Home Address: _________________________________


    School last Attended: __________________________________________________________________________________________

    To be accomplished by the psychometrician or representative as applicable.

    [ ] ENTRANCE EXAM RESULT: ______ Remarks: __________________ _______________ _________________________


    Signature Over Printed Name
    Psychometrician

    [ ] INTERVIEW: ___________________________ [ ] MEDICAL EXAM: ___________________ _________________________


    Signature Over Printed Name
    Date of exam: _______________ Exam Result: __________ Course Applying for: ______________ O.R.#: ____________ Dean
    2x2
    Name: _________________________________________________________________ Date of Birth: ________________
    Colored
    Family name First Name Middle Name
    Age: ______ Gender: ________ Contact No./s: ______________________________ Email: _______________________ Picture

    School last Attended: _________________________________________________________________________________

    Copy of Guidance Office

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