PIC FORM E101

PACIFIC
INTERCONTINENTAL
COLLEGE Insert 2”x2” Latest
Colored Picture
“Transnational Education Provider”

Lot 20 Block 30, Silver Corner, Marble Road, Pilar Village Las Piñas City
Philippines 1750.
Email: pic1@pic.edu.ph Contact Number: (632)872-0773; 478.7710
Website: www.pic.edu.ph

Fill up the form below with correct details.

Applicant’s Information

Surname Name Middle Name

Primary Email: Status:

Secondary Email: Gender:
Contact Number: Citizenship:
Foreign Number: Nationality:
Place of Birth: Birthday:
Current Address:
Foreign Address (If Applicable): Country to Stay:
City: Province:
Country: Zip Code:
PRC Number: PRC Registration Date:
Foreign National (ACR No.)
Institution:
Name of Recommended:
Passport Number (If Eligible Student residing outside the Philippines):
Date Departed in the Philippines:

PROGRAM YOU WANTED TO ENROLL

Degree Program: PTCP BACHELORS MASTERS PHD

Preferred Major Study/Specialization:

Previous School Graduated:
Self-Introduction/Study Plan:

REMARKS: If foreign student or Filipino residing in foreign countries subject to school regulation
 PIC FORM E101

*Required Document:
 Transcript of Record from previous school
 Resume
 Certificate of Graduation (Shall be Original)
 1st page of passport with picture
 Birth Certificate
 Marriage Certificate (For Woman)
 2x2 Picture

By filling this form, you certify that the foregoing information are true and correct to the best of your knowledge and you fully
realize the omission or falsification of any information will be considered sufficient reason for the rejection or dismissal of this
application.
NON-DICRIMINATORY DECLARATION
Pacific InterContinental College admits students and faculty of any race, creed, color, national and ethnic origin to all of the
rights, privileges, programs, and activities generally accorded or made available to students at the Institute. It does not
discriminate on the basis of race, color, creed, national and ethnic origin in the administration of its educational policies,
admissions policies, scholarships and other school - administered programs.

________________________________ _______________________
Applicant’s Signature: Date: