Republic of the Philippines

UNIVERSITY OF NORTHERN PHILIPPINES

College of Medicine
Tamag, Vigan City
2700 Ilocos Sur

APPLICATION FORM FOR FRESHMEN

Academic Year 2023-2024
First Name:
Middle Name:
Last Name:
Email Address:
Contact Number:
Facebook/Messenger Account Name:
Zoom Account:
Age: Sex: Civil Status:
Date of Birth:
Citizenship:
Place of Birth:
Contact Number:
Present Mailing Address:
Place where you have resided the longest:
Parents (Indicate if deceased)
Father:
Occupation:
Address:
Telephone:

Mother:
Occupation:
Address:
Telephone:

If a parent is employed at UNP, Name of College/Unit:

TYPE OF APPOINTMENT:
☐Regular ☐Part-Time ☐Temporary ☐Permanent

Guardian:
Name:
Occupation:
Address:
Telephone:

Person responsible for your well-being if you live within the vicinity and not residing with
neither parents nor guardian
Name:
Occupation:
Address:
Telephone:

Quirino Blvd., Brgy. Tamag, Vigan City, 2700 Ilocos Sur

ISO 9001:2015
Website: www.unp.edu.ph
REGISTERED
Email: cmed@unp.edu.ph Telephone # (077)607-5159 Certificate. No. SCP000580Q
 Republic of the Philippines
UNIVERSITY OF NORTHERN PHILIPPINES
College of Medicine
Tamag, Vigan City
2700 Ilocos Sur

• WORK EXPERIENCE:

• EDUCATIONAL BACKGROUND: (List of Schools/Universities/Academic Institutions attended

or currently attending should be in CHRONOLOGICAL order)
Primary Secondary Tertiary

TO THE APPLICANTS: (Use additional sheets if necessary)

The members of the Admissions Committee wish to know some things about yourself. Please
submit a brief biographical sketch using the following guide:

1. How would you describe your family?

2. Extracurricular and/or community activities participated within the last four years.

Quirino Blvd., Brgy. Tamag, Vigan City, 2700 Ilocos Sur

ISO 9001:2015
Website: www.unp.edu.ph
REGISTERED
Email: cmed@unp.edu.ph Telephone # (077)607-5159 Certificate. No. SCP000580Q
 Republic of the Philippines
UNIVERSITY OF NORTHERN PHILIPPINES
College of Medicine
Tamag, Vigan City
2700 Ilocos Sur

• REFERENCE PERSONS:
Name Address Contact Number

2x2 Picture

_____________________________________
Signature over printed name

DO NOT WRITE ANYTHING BELOW THIS LINE:

NMAT: UNP-MAT:
Interview: O.R. No: Date Paid:
Date Filed:

Quirino Blvd., Brgy. Tamag, Vigan City, 2700 Ilocos Sur

ISO 9001:2015
Website: www.unp.edu.ph
REGISTERED
Email: cmed@unp.edu.ph Telephone # (077)607-5159 Certificate. No. SCP000580Q
 Republic of the Philippines
UNIVERSITY OF NORTHERN PHILIPPINES
College of Medicine
Tamag, Vigan City
2700 Ilocos Sur

APPLICATION PROCESS OF THE COLLEGE OF MEDICINE

Applicants may choose to submit their requirements via courier or online:
1. Properly accomplished application form (can be downloaded at our official Facebook page and
also available at the College of Medicine Office)
2. Four copies of 2x2 pictures with signature over printed name at the back of the pictures
3. National Medical Admission Test (NMAT) original and/ or certified true copy with a score of 50%
or higher. Must not exceed more than two (2) years from the time of application.
4. Certified true copy of Transcript of Record of the Baccalaureate Program.
5. Certified true copy of Diploma or Certificate of Graduation authenticated by the Registrar of the
school where the applicant graduated (for graduates of government school)
6. Certificates of Academic/Class Ranking and General Weighted Average.
7. Certificate of Honorable Dismissal/ Permit to Transfer, if applicable.
8. Certificate of Good Moral Character
9. Letter of Recommendation from two (2) former professors in the last school attended stating
among others that applicant has no derogatory record and addressed to the Dean of the College
of Medicine;
Pablo R. Quedado, MD
Dean, College of Medicine
University of Northern Philippines
Tamag, Vigan City, Ilocos Sur
10. Birth Certificate issued by the Philippine Statistics Authority (PSA).
11. For Naturalized Filipino citizens, an original Certificate of Naturalization is required. ONLY
original Certificates of Naturalization and other documents issued by the Commission on
Immigration and Deportation shall be accepted.
12. Once the College has received and confirmed that all requirements have been complied with,
the applicant shall be notified of the interview process.
13. For questions and concerns, applicants may leave a message at our official Facebook page,
UNP – College of Medicine, at our alternative Facebook account, Cmed Unp, or email us at
cmed@unp.edu.ph

Contact Numbers:
+63-905-434-3043
(077) 604-5159

Quirino Blvd., Brgy. Tamag, Vigan City, 2700 Ilocos Sur

ISO 9001:2015
Website: www.unp.edu.ph
REGISTERED
Email: cmed@unp.edu.ph Telephone # (077)607-5159 Certificate. No. SCP000580Q