CHINESE GENERAL HOSPITAL COLLEGES

286 Blumentritt St., Sta. Cruz, Manila 1014

Trunk Line Number: (632) 711-41-41 Local 601 ● Telefax: (632) 711-00-75
Accounting Office: (632) 743-21-29 ● Registrar’s Office: (632) 743-89-41

APPLICATION FOR COLLEGE ENTRANCE EXAMINATION

2 x 2 colored ID
picture with white
Degree/Program Applied: (Please check)
background
 Bachelor of Science in Nursing (wearing white polo
□ Bachelor of Science in Medical Laboratory Science with collar)
(Bachelor of Science in Medical Technology)

□ Bachelor of Science in Radiologic Technology

□ Bachelor of Science in Physical Therapy
□ Bachelor of Science in Psychology

Please check:

 Senior High School Graduate: Track/Strand: ABM

□ Transferee □ Second Courser

PERSONAL INFORMATION

NAME:______QUILO_______________PATRICIA______________________________
(Last Name) (First Name) (Middle Name)

HOME ADDRESS: _2701 INTERIOR 1 LICO STREET TONDO MANILA ___

SEX: FEMALE AGE: 17 DATE OF BIRTH (mm/dd/yyyy): SEPTEMBER 30 2002
LANDLINE NUMBER: (781-98-85 ) MOBILE PHONE: 0961-383-7514

EDUCATIONAL BACKGROUND
SENIOR HIGH SCHOOL: UNIVERSITY OF THE EAST ____
SCHOOL ADDRESS: 2219 Recto Ave, Sampaloc, Manila, 1008 Metro Manila
MONTH AND YEAR GRADUATED/EXPECTED TO GRADUATE: APRIL 29 2002
(For Transferees/Second Coursers Only)
COLLEGE: ______________________________________________________________
DEGREE/PROGRAM: _______________________________________________________
SCHOOL ADDRESS: _______________________________________________________
YEAR LAST ATTENDED: _____________________________________________________

To Be Filled Out By CGHC Guidance, Counseling and Testing Office:

Temporary Student ID Number: ______________________________________________
Date Submitted: ____________________________________________________
Examination Schedule: (Date) __________ (Time) _________ Venue: ___________
O.R. Number: _________________ Date Paid: ____________________________
Application Form Received By: __________________________________________
Learned about CGHC through:

 School career fair/Brochures/Flyers

 Website/Facebook
 Relatives
 Friends
 Others (please specify): __________________________

General Application Requirements (Entrance Exam)

□ Accomplished application form
□ Photocopy of PSA-Authenticated Birth Certificate
□ Original Certificate of Candidacy for Graduation/Certificate of Graduation with specific track
and strand taken
□ Four (4) pieces identical and recent 2x2 colored ID picture with white background (wearing
white polo with collar)
□ One (1) piece long ordinary folder
□ One (1) piece long plastic envelope
□ Two (2) pieces long brown envelope
□ Official receipt of payment for the application fee (₱500.00)
Additional Requirements For Transferees/Second Coursers:

□ Certified True Copy of Grades/Scholastic Records/Transcript of Records

Note: Transferees and Second Coursers are required to proceed to the Chinese General
Hospital Colleges Guidance, Counseling and Testing Office for preliminary assessment of
academic status prior to entrance examination application.

The information that you supply in this form will be entered into a filing system and will
only be accessed by
authorized persons of the Guidance, Counseling and Testing Office of Chinese General Hospital
Colleges. The information will be retained by the College and will only be used for the purpose of
processing your Application for Admission. By providing such information, you consent to the College
storing the information for the stated purpose. The information is held by the College in accordance
with the provisions of the Data Privacy Act of 2012.
“I certify that the foregoing information is true and correct made in good faith and verified by me to the
best of my
knowledge and belief. I understand that when this information is no longer required, official college
procedure will be followed for its disposal.”
 PATRICIA QUILO
SIGNATURE OVER PRINTED NAME OF STUDENT

DATE SIGNED

GCTO-AEE
Revised 10/2019