ILOILO DOCTORS' COLLEGE

OFFICE OF ADMISSION
West Avenue, Molo, Iloilo City 500
Tel. No.: (033) 337-0034

APPLICATION FOR ADMISSION

O.R. No.:
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: DOCTOR OF DENTAL MEDICINE
If Alien, ACR # (See Registrar): BS PHYSICAL THERAPY
Civil Status: BS SOCIAL WORK
Permanent Mailing Address: BS PSYCHOLOGY
Contact No.: Email Address: M F BS BIOLOGICAL SCIENCE
Place of Birth: Date of Birth: BSBA Major in Human Resource Management
Religion: Age: BSBA Major in Financial Management
S M W BS COMPUTER SCIENCE
Parent/Guardian: BS INFORMATION TECHNOLOGY
Relation to Applicant: Contact No.: BS INFORMATION SYSTEM
Address: DIPLOMA IN MIDWIFERY
BS MIDWIFERY
If Married: ASSOCIATE IN RADIOLOGIC TECHNOLOGY
Name of Spouse: Citizenship: BS RADIOLOGIC TECHNOLOGY
Contact No.: No. of Children: 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)
Senior High School (11-12)
College
Are you coming in as a Scholar?
If YES, Please check the appropriate sponsoring agency:
Others (Pls. specify)___________________________________________
YES NO
Are you interested in applying for any of the IDC Scholarship Programs?
If YES, Please check the scholarship that you are applying:
CHED TESDA Iloilo City Scholar
Entrance Scholarship AFP Educational Benefit System Working Student
YES
Athletic Scholarship
Volleyball Basketball Karatedo
Table Tennis Badminton
Does your family receive any assistance from DSWD?
If YES, check the appropriate DSWD assistance:
Senior Citizen 4P's Listahanan Others (Pls. specify)_______________________________________________
YES NO
Are you a member of any non-campus based social organization/partylist?
If YES, please specify: _____________________________________________________________________________________________________
Honors/Awards/Distinctions Received:
Temporary Enrollment Waiver Issued by: ____________________________________ Date: ________________________________
 PERSONAL DATA SHEET

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

Senior High School Graduate (For Academic Department Use Only)

____ HS Card Name of Student:

____ Cert. of GMC Advised to Enroll
____ PSA 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
____ PSA 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
06,2017