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    Uploaded by

    Lealyn Pagsinuhin Bobadilla
    This document is a student application form for Golden Gate Colleges. It collects personal information from applicants such as name, address, education history, health records, and reasons for choosing the school. It must be filled out accurately and submitting supporting documents as incomplete or false information could impact admission eligibility.

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

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    Uploaded by

    Lealyn Pagsinuhin Bobadilla
    8 views2 pages
    This document is a student application form for Golden Gate Colleges. It collects personal information from applicants such as name, address, education history, health records, and reasons for choosing the school. It must be filled out accurately and submitting supporting documents as incomplete or false information could impact admission eligibility.

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    © © All Rights Reserved

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    This document is a student application form for Golden Gate Colleges. It collects personal information from applicants such as name, address, education history, health records, and reasons for choosing the school. It must be filled out accurately and submitting supporting documents as incomplete or false information could impact admission eligibility.

    Copyright:

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

    CONN

    Uploaded by

    Lealyn Pagsinuhin Bobadilla
    This document is a student application form for Golden Gate Colleges. It collects personal information from applicants such as name, address, education history, health records, and reasons for choosing the school. It must be filled out accurately and submitting supporting documents as incomplete or false information could impact admission eligibility.

    Copyright:

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

    P. Prieto St., Batangas City, Batangas


    Attached
    Tel. No. (043) 723-2663 loc. ___ 2X2
    Website: www.goldengatecolleges.net
    Picture here
    Email: __________________________

    STUDENT’S DATA QUESTIONNAIRE/APPLICATION FORM


    Application Date:________________ Application Type: New Transferee Cross-enrollee
    Program Preference:
    BSN (Bachelor of Science in Nursing)

    PERSONAL INFORMATION: Print legibly. Mark appropriate boxes with “X”.


    LAST NAME:

    FIRST NAME:

    MIDDLE NAME: NAME EXTENSION (E.G. Jr., Sr.):

    SEX: Male Female CITIZENSHIP: RELIGION: AGE:

    DATE OF BIRTH (mm/dd/yyyy): PLACE OF BIRTH: CIVIL STATUS:

    PRESENT ADDRESS: ZIP CODE:

    PERMANENT ADDRESS: POSTAL CODE:

    TELEPHONE NO.: MOBILE NO.: EMAIL (if any):

    FAMILY BACKGROUND (Use separate sheet if necessary)


    HIGHEST
    CIVIL MONTHLY
    NAME AGE CITIZENSHIP EDUCATIONAL OCCUPATION
    STATUS INCOME
    ATTAINMENT
    FATHER:

    MOTHER:

    SIBLINGS:

    PARENTS’ ADDRESS:
    (Fill – out only this portion if applicant is living with Guardian)

    GUARDIAN’S NAME: RELATIONSHIP:

    OCCUPATION: CONTACT NO.:

    ADDRESS:

    PERSON TO BE NOTIFIED IN CASE OF EMERGENCY: _____________________________________________________________


    CONTACT NO.: _______________________________

    EDUCATIONAL BACKGROUND

    JUNIOR H.S.:
    NAME OF SCHOOL SCHOOL ADDRESS INCLUSIVE DATES GEN. AVE.

    GRADUATE S.:

    HONORS/AWARDS RECEIVED: ________________________________________________________________________________


    ___________________________________________________________________________________________________________

    HOBBIES/TALENTS: __________________________________________________________________________________________
    ___________________________________________________________________________________________________________

    SOCIAL ACTIVITY/AFFILIATION

    NAME OF ORGANIZATION POSITION INCLUSIVE YEARS

    HEALTH RECORD
    Any health problem that may affect the performance in school: _________________________________________________________
    Are you under a medication maintenance program? Yes No If yes, please specify: ______________________________
    Physical Deformities Vision Hearing Others (please specify): ______________________________

    Why I chose to enroll at Golden Gate Colleges


    ___________________________________________________________________________________________________________
    ___________________________________________________________________________________________________________

    I further affirm that all information supplied herein are complete and accurate. I am aware that any on all of the information furnished in
    this application may be checked against original documents and that giving or withholding or giving false information will make me
    ineligible for admission or subject to dismissal. If admitted, I agree to abide by the policies, rules and regulations of the Golden Gate
    Colleges.

    Date Student’s Signature Date Parent’s Signature

    To be filled out by GGC Staff.

    SUBMITTED CREDENTIALS
    [ ] Form 138 (Report Card)/ Transcript of Records (TOR)/ Certificate of Grades
    [ ] Certificate of Good Moral Character
    [ ] Honorable Dismissal
    [ ] Photocopy of Marriage Contract (if married)
    [ ] Photocopy of NSO Authenticated Birth Certificate
    [ ] Pictures
    [ ] NCAE Results

    Interviewed by: _______________________________ Admission Status:


    Signature over Printed Name/Date [ ] Accepted [ ] On Probation

    Designation: _______________________________ Received by: ____________________________

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