``` Kalayaan College Clip two (2) 2”x2”
APPLICATION FORM photograph taken within
22 Manga Road cor. Aurora Boulevard, the last 6 months.
New Manila, Quezon City
Sign your name on the back
of each photograph.
PRINT in ink or TYPE legibly. Submit together with the requirements cited below.
ONLY APPLICATIONS ACCOMPLISHED COMPLETELY WILL BE PROCESSED.
Requirements:
For Freshman Students For Transfer Students
Original copy of Fourth year Report Card Official Transcript of Records
Certificate of Graduation Honorable Dismissal
Birth Certificate
Birth Certificate Birth Certificate
Application is made as a: Freshman Student Transfer Student 2nd Undergraduate degree
Application is made for: 1st Semester 2nd Semester _______School Year
PROGRAM CHOICES for Degree Program / Course:
First Choice
Second Choice
Third Choice
PERSONAL DATA. Place one letter in each box. Leave one box blank between names.
Last Name
First Name
Middle Name
Permanent Mailing Address
Telephone #
Email Address
Sex: Male Female Civil Status: Single Married (Name of spouse)
Citizenship Filipino Non-Filipino (Specify)
Date of Birth - - Place of Birth
Year Month Day
HIGH SCHOOL (Where you completed/are completing secondary level education):
Name of School (Do not abbreviate) Address (City/Town, Province) Expected / Date of Completion
SCHOOLS ATTENDED (List in chronological order all the schools attended starting from primary school)
Educational Level Name and Address Dates Attended
__________________________ ___________________________________________ ____________________________
__________________________ ___________________________________________ _______ _____________________
__________________________ ___________________________________________ _______ _____________________
__________________________ ___________________________________________ ____________________________
__________________________ ___________________________________________ _______ _____________________
HONORS/AWARDS/DISTINCTIONS RECEIVED
_________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________
FAMILY BACKGROUND
FATHER MOTHER GUARDIAN
Name
Mailing Address
Email Address
Occupation
Name of Employer
Business Address
Office Telephone #
Annual Gross Family Income
Person to be notified in case of emergency:
Name: _________________________________________________________ Relationship: ______________________
Address: __________________________________________________________________________________________
Telephone #: ____________________ Mobile #: ______________________ Email Address: ______________________
MEANS OF FINANCIAL SUPPORT
Parents Self Loan Scholarship Educational plan, specify: ______________________
If self-supporting, state annual gross income _______________________ Present Occupation ______________________
Business address: ___________________________________________________________________________________
CERTIFICATION
A. I affirm that:
1. I have read and understood all instructions relevant to my application.
2. All the information supplied in this application form is true, complete and accurate.
3. I am aware that the information furnished in this application may be checked against original documents and that
withholding or giving false information will disqualify me from admission/will be a basis for dismissal, if
admitted.
___________________ __________________________________________
DATE SIGNATURE OF STUDENT
B. I certify that the information furnished in this application form by my son/daughter/dependent is true, complete, and
accurate. I recognize that in signing this application form, I share with my son/daughter/dependent the responsibility
for the veracity and completeness of the information supplied herein.
___________________ __________________________________________
DATE SIGNATURE OF PARENT/GUARDIAN
