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Far Eastern University

APPLICATION FORM FOR ADMISSION


SY 20 Local - 20 International

DR. NICANOR REYES MEDICAL FOUNDATION


INSTITUTE OF MEDICINE
Tel. N .% &'()*'+, L #. ++&& -e.site% !!!."eu)nrm"./0

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Surname First Name Middle Name 5e")er


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Female

Date of Birth Age Height &eight Pla(e of Birth

Civil Status Citize"shi# 'eligio"

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No. (Include Bldg Name) Street

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Name o& Sc'ool$(n !er" t#

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Degree$Cour"e )ear *rad.

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+onor" Rece !ed

Date +MAT Ta$e"

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Per(e"tile 'a"$ Have /ou 1ee" a)mitte) i"to a"/ me)i(al s(hool 1efore4 +o &here4 Yes &he"4

Have /ou a##lie) for a)missio" to the 0"stitute of Me)i(i"e2 F-3-+'MF 1efore4 +o Yes &he"4

H ! d y u intend t "inan#e y ur medi#al studies$

F-3-Dr* +i(a"or 'e/es Me)i(al Fou")atio"


Tel* +o* 92:-02;< =o(* ;;99 &e1site %%%*feu-"rmf*#h

Amou"t Pai) 'e(ei#t +o* Date of 'e(ei#t S(hool of Me)i(i"e A)missio" Offi(e

A##li(a"t.s Co#/ Date +ame


Sur"ame First +ame M*0*

A##li(atio" +o*

'e(eive) 1/

Date

Far Eastern University

DR. NICANOR REYES MEDICAL FOUNDATION


INSTITUTE OF MEDICINE
Tel. No.: 427-0213 Loc. 1144 Website: www. e!-nr" .#$

0m#orta"t 'emi")ers
NON-REFUNDABLE & NON-TRANSFERABLE APPLICATION FEES THIS FORM IS NOT FOR SALE THIS FORM CAN BE REPRODUCED

F-3-+'MF A##li(atio" Pro(e)ure for S(hool of Me)i(i"e


; Secure list o re!uire"ents at t#e Me$icine A$"ission O ice% U&'% IM Bl$() or at t#e FEU-NRMF *e+site) 2 Pa, t#e a--lication an$ -rocessin( ee to an, RCBC Co""ercial Ban. nation/i$e% Mon$a,-Fri$a,% 0122-'122-"% usin( t#e Bills Collection Sli- or at t#e FEU-NRMF IM Bl$() Accountin( O ice% L&3% Mon$a,-Fri$a,% 4122-5122-" < Su+"it re!uire"ents or a$"ission to(et#er /it# t#e acco"-lis#e$ a--lication or" or" /it# -icture) Present recei-t o a--lication ee -a,"ent to t#e Me$icine A$"ission O ice

F-3-+'MF Che($list of Su1mitte) 'e>uireme"ts


Ori(inal Transcri-t or Sc#olasti Recor$s 6t/o 678 -#otoco-ies T/o 678 Certi icates o &oo$ Moral C#aracter ro" t/o 678 or"er -ro essors Certi ie$ True Co-, o Birt# Certi icate ro" t#e National Statistics O ice Marria(e Certi icate% /#en a--lica+le Alien Certi icate o Re(istration 6ACR8 or international stu$ents T#ree 797 -#oto(ra-#s ta.en /it#in t#e last si9 6:8 "ont#s o a--lication) One Lon( Bro/n En;elo-e

All in or"ation an$ $ocu"ents as.e$ or in t#is or" s#oul$ +e su+"itte$ in or$er or t#is a--lication to +e -rocesse$) False in or"ation /ill in;ali$ate t#is a--lication an$ /ill result to i""e$iate re<ection o t#e a--licant) I #ere+, certi , t#at I #a;e rea$ care ull, all t#e ore(oin( an$ t#at all in or"ation (i;en an$ $ocu"ents su+"itte$ are true an$ correct to t#e +est o ", .no/le$(e) I a$"itte$% I s#all a+i$e +, all t#e re(ulations an$ -olicies or"all, -ro"ul(ate$ +, t#e FEU-Dr) Nicanor Re,es Me$ical Foun$ation)

Si(nature o A--licant a+o;e Printe$ Na"e

Date

All announce"ents s#all +e -oste$ on t#e Bulletin Boar$% irst loor lo++,% Institute o Me$icine an$ at t#e FEU-NRMF /e+site) A--licants are e9-ecte$ to re-ort or inter;ie/ on t#e sc#e$ule$ $ate an$ ti"e)

Selection is +ase$ on &*A ro" Bac#elor=s De(ree) NMAT Percentile an$ Personal Inter;ie/)
>uali ie$ a--licants /ill +e noti ie$ +, e-"ail or cell-#one an$ "a, enroll a ter un$er(oin( a co"-lete P#,sical E9a"ination) All in!uiries s#oul$ +e $irecte$ to t#e C#air"an o t#e A$"ission Co""ittee% FEU-NRMF Sc#ool o Me$icine

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