[QF-ASR-027]

MANILA CAMPUS
1113-1117 San Marcelino Street
Paco , Manila, Philippines
Telephone: (632) 521-2710 loc. 6535/5371
Telefax: (632) 521-2710 loc. 5371
Email: admission@eac.edu.ph
Website: www.eac.edu.ph
2x2
CAVITE CAMPUS
Congressional East Avenue Burol Main
City of Dasmariñas, Cavite, Philippines
Telephone: (046) 416-4341to 42 loc. 106
Email: admission-cavite@eac.edu.ph
Website: www.eac.edu.ph/cavite
COLLEGE APPLICATION FORM
Application is made for:
Degree/Certificate Program: BACHELOR OF SCIENCE IN MEDICAL TECHNOLOGY Filipino Foreign
Term: 1st Sem 2nd Sem Summer Academic Year: 2019-2020
Classification: Freshman Transferee
Second Courser Cross-Enrollee

I. PERSONAL INFORMATION
Last/Family Name: First Name: Middle Name: Learner's Reference No. (LRN):
ABEJO ANGELIC ROSS CLARIDAD 136912060002
Gender: Religion: Citizenship:
FEMALE Roman Catholic FILIPINO
Date of Birth: Place of Birth: Age:
2001-02-08 TARLAC 18
Apartment Name/ House No/ Street/ Barangay:
BLK 4 LOT 2, NA, KUA AREA F
City/Municipality: Country: Zip code:
CAVITE CITY PHILIPPINES 4117
Civil Status: Single Married Widowed Divorced Maiden Name (If Married Female):

Mobile No: Email: Facebook: Twitter:

09773729549 Angelicabejo8@gmail.com ANGELIC.CLARIDAD@YAHOO.COM NA

I.I. ALIEN STATUS INFORMATION (For Foreign student only)

Visa Status: Period of Authorized Stay:
0000-00-00
Passport No: Place of Issue: Exp. Date:

ACR No: Date of Issue: Exp. Date:

CRT No: Date of Issue: Exp. Date:

II. EDUCATIONAL BACKGROUND

School Level School Type School Name School Address Year General
Graduated Average
Elementary:
Public CUPANG ELEMENTARY SCHOOL CUPANG MUNTINLUPA CITY 2013 84.00
Junior High School:
Public Muntinlupa National High School POBLACION, MUNTINLUPA CITY 2017 90.00
Senior High School:
Private University Of Perpetual Help System Dalta ALABANG-ZAPOTE ROAD, PAMPLONA, LAS PI?AS CITY 2019 85.50
College/University &
Degree: Private NA NA 0.00
Graduate School &
Degree: Private NA NA 0.00

III. FAMILY INFORMATION

Father's Name: Mother's Name:
ABEJO, JELFREN P. ABEJO, BELINDA C.
Home Address:
594 PUROK 5 CUPANG MUNTINLUPA CITY
Affliation:
N.A. N.A.
Occupation:
EMPLOYEE HOUSEWIFE
Deceased:
No No
Mobile No:
09297995709 09297995709
Company Name and Address:
NA NA
Highest Educational
Attainment: COLLEGE UNDERGRADUATE HIGH SCHOOL GRADUATE
IV. SIBLINGS
No. of Siblings: No. of Brothers: No. of Sisters:
7 3 4

V. EMERGENCY CONTACT
Name Relation
JOSEFINA BOQUIA AUNTIE
Home Address Contact No.:
BLK 4 LOT 2 BRGY. KUA AREA F, GMA, CAVITE 09272088234
Monthly Income of Parents: Living Arrangement: Source of Financial Support:
Others Living with Guardian Only Relatives

VI. OTHER INFORMATION

I learned about EAC through: (Please tick all that apply)

EAC Representative who visited our school for Career Fair/Career Talk

EAC Facebook

EAC Website

Brochures/Flyers/Posters/Banner/Tarpaulin

Referral from a friend (student) from EAC

Referral from EAC Employee

Referral from EAC Alumnus

My Parents/Relatives

Others

Reasons for applying at Emilio Aguinaldo College

Choose the three main reasons and rank according to importance, 1 being the most important:

1st Reason: Affordable fees

2nd Reason: High Passing Rate in board exams
3rd Reason: Easily accessible

VII. CERTIFICATION
TERMS OF REFERENCE:
I hereby attest to the completeness and accuracy of all information supplied in this form. I understand that withholding of information or giving
false information may nullify my application for admissions or may jeopardize my continued stay after admission has been granted.

TERMS OF REFERENCE:
By choosing 'I Accept' below, I voluntarily agree to the Emilio Aguinaldo College (EAC) Privacy Policy and declares that:

I am of legal age.
I am confirming that all the information I provide are true and correct.
I understand that withholding of information or giving of false information may nullify my application for admission or may jeopardize my
continued stay after admission has been granted.
I am giving my consent to the collection, use, processing, recording, storage, blocking, destruction, and disclosure of the information I provided
for legitimate purposes in order to administer and evaluate the eligibility of my application for admission at EAC.

Note: The accomplished Application Form should be printed, signed by the applicant, and submitted to the EAC Admissions and Student Recruitment Office.

I agree with the terms of references.

ABEJO, ANGELIC ROSS C. May 14, 2019

Signature over Printed Name of Applicant Date