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    UC-MED Application Form

    Uploaded by

    FreakyRustlee Leorag
    This document is an application form for admission to the University of Cebu College of Medicine for the 2017-2018 academic year. It requests personal information about the applicant such as name, age, address, educational background, family details, and personal views. The applicant must certify that all information provided is true and correct. The form notes that any false information could invalidate the application.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    UC-MED Application Form

    Uploaded by

    FreakyRustlee Leorag
    358 views2 pages
    This document is an application form for admission to the University of Cebu College of Medicine for the 2017-2018 academic year. It requests personal information about the applicant such as name, age, address, educational background, family details, and personal views. The applicant must certify that all information provided is true and correct. The form notes that any false information could invalidate the application.

    Original Description:

    Uc med apply

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    This document is an application form for admission to the University of Cebu College of Medicine for the 2017-2018 academic year. It requests personal information about the applicant such as name, age, address, educational background, family details, and personal views. The applicant must certify that all information provided is true and correct. The form notes that any false information could invalidate the application.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    358 views2 pages

    UC-MED Application Form

    Uploaded by

    FreakyRustlee Leorag
    This document is an application form for admission to the University of Cebu College of Medicine for the 2017-2018 academic year. It requests personal information about the applicant such as name, age, address, educational background, family details, and personal views. The applicant must certify that all information provided is true and correct. The form notes that any false information could invalidate the application.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    University

    of Cebu College of Medicine Foundation, Inc.

    S C H O O L O F M E D I C I N E


    APPLICATION FOR ADMISSION
    ACADEMIC YEAR 2017-2018

    Name___________________________________________________________
    (Family) (First) (Middle)

    ATTACH A RECENT
    (Do not fill this box)
    2 X 2
    1. Application no________ 2. Issued ____________ 3. Amount paid _____________
    PHOTOGRAPH
    A. GWA _______________ B. Interview _________ C. NMAT ___________________
    HERE
    Date filed: _____________

    I. Personal Information: (Please type or print in ink)

    School last attended: ___________________________________ Course: _____________ Date of Graduation: ___________

    Age: __________ Gender:_______ Civil Status: _____________ Religion: ______________________

    Place of Birth: ____________________________________________ Date of Birth: ___________________________

    Citizenship: Filipino
    Natural-born

    Naturalized (attach supporting papers)



    Others (pls. specify) __________________________

    Home Address: _______________________________________________________________________

    Present Mailing Address: _______________________________________________________________

    Country: __________________________________________ Postal Zipcode: _____________________

    Telephone No. / CP: _________________________________ Email address: _______________________

    II. Educational Background: (List of all the schools you have attended or are attending)
    School / Location Inclusive date of Certificate / Degrees Date Certificate/
    attendance earned or course Degree received
    currently enrolled in

    Is this the first time you are applying for admission to a medical school? YES NO If not, where, when, (year/s)
    did you apply, and what happened to your application(s)?

    Are you concurrently applying for admission to a medical school other than UC School of Medicine? If yes, at what medical
    school(s)?

    University of Cebu Banilad Campus, Gov. Cuenco Avenue Banilad Cebu City. 232-1525. collegeofmedicine@uc.edu.ph


    University of Cebu College of Medicine Foundation, Inc.

    S C H O O L O F M E D I C I N E


    III. Family Background:

    A. Parents (Indicate if deceased)


    Father: ___________________________________________________ Occupation: _________________________
    Address: __________________________________________________ Telephone /CP: ______________________
    Mother: ___________________________________________________ Occupation: _________________________
    Address: __________________________________________________ Telephone /CP:______________________

    B. Person supporting you other than your parents


    Name: ____________________________________________________ Occupation: _________________________
    Address: ___________________________________________________ Telephone / CP: _____________________

    C. Guardian (If any)


    Name: ____________________________________________________ Occupation: ________________________
    Address: __________________________________________________ Telephone / CP: _____________________

    D. Person responsible for you in the city if you are not residing with either your parents or guardian
    Name: ____________________________________________________ Occupation: ________________________
    Address: __________________________________________________ Telephone / CP: ____________________

    IV. Personal Views

    A. Why do you want to be a medical doctor?







    B. What can you say about your family?





    C. What special talent or skill can you contribute to UC College of Medicine?

    APPLICANT'S CERTIFICATION

    I hereby certify on my honor that all the information herein contained is true and correct and that I am not
    currently enrolled in any medical school, otherwise my application for entrance in this university will be rendered
    invalid.

    Signature of Applicant

    University of Cebu Banilad Campus, Gov. Cuenco Avenue Banilad Cebu City. 232-1525. collegeofmedicine@uc.edu.ph

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