Form VCA 1

V E L E Z C O L L E G E, I N C Please attach one

2X2 colored ID
. picture with white
Cebu City, Philippines background
GUIDANCE OFFICE
Tel No.: (032) 253-2018
APPLICATION FOR NEW STUDENT
Thank you for your interest in Velez College. If you have any questions in completing this application,
please call (032) 253-2018 or email us at admission.at.velez@gmail.com. Please fill out the form legibly.

I. PERSONAL INFORMATION
NAME OF APPLICANT (Surname) (First Name) (Middle Name)
in CAPITAL letters:

Date of Birth: (mm/dd/yyyy) Place of Birth: Male Female

Present Address: Zip Code:

Permanent Address (if different from present address): Zip Code:

(Landline) (Mobile Phone) Email Address:

Contact Number:
Religion From Birth: Current Religion:

Dialects/Languages spoken at home: Dialects/ Languages Most Fluent in: Citizenship:

II. FAMILY BACKGROUND

Fathers Name: Occupation:

Mothers Name: Occupation:

Parents Landline: Mothers Mobile Phone #:

Parents Email Address: Fathers Mobile Phone #:

III. EDUCATIONAL BACKGROUND

Grade/Year Level Name of School Address Inclusive Dates Honors Received
Completed
Elementary

High School

IV. CONTACT IN CASE OF EMERGENCY

Name of Person:

Relationship: Phone No. (Home) Mobile Phone #:

Address: Zip Code:

I hereby certify that all entries herein are true and correct.

Date of Submission: ______________________ Students Signature: _____________________

Office of Student Services and Affairs: (032) 253- 2018 Email: admission.at.velez@gmail.com