information and thus, has adapted the necessary measures to secure it. JHCSC is bound to comply with the Data Privacy Act of 2012 (RA
By filling out this form, you are consenting to our collection of your information in accordance with this privacy notice. consent.
New student Transferee Returnee Second courser Shiftee
School year: First semester Second semester Summer
Student name: Family name First name Middle name Name extension
Course: Year level: Major area:
Ethnicity: Civil status: Religion: Date of birth: Place of birth: Sex at birth: Gender preference: Mobile number: Email address: Present address: Barangay Town/City Province ZIP Code
Home address: Education: Level School name Address Strand Private or Public? Elementary Secondary School last attended: Last term of attendance: (School year and/or semester) Supporting financially: Parents Guardian Others (specify):
Parent’s/guardian’s name: Occupation:
Parent’s/guardian’s monthly income: Below P10,957 P10,957 to P21,914 P21,914 to P43,828
P43,828 to P76,66 P76,669 to P131,484 Above P132,000
Parent’s/guardian’s contact No.: Is your family a 4Ps beneficiary? Yes No
Are you a member of an Indigenous community (IP): Yes No If Yes, please specify:
Are you a first-generation college student? Yes No
(First-generation college students refer to those who are the first in their immediate families to pursue a college degree. Their parents and siblings (if any) were not able to go to college)
ENROLLMENT STEPS (Have this form signed by the personnel attending to you)
STEPS ACTIVITY SIGNATURE
1 ADMISSION (Slot verification)
2 SUBJECT ENLISTMENT (Subject verification)
3 STUDENT AFFAIRS (Taking of ID picture, submission of filled out forms) ID Incharge
Guidance Medical DSA 4 REGISTRAR (Validation of enrollment, submission of enrollment requirements/documents and printing of COR) Note: Submit this form together with your enrollment requirements to the Registrar’s Office.
