Be a Lukan M.D.

APPLICATION FORM
St. Luke’s Medical Center College of Medicine Requirements

FRESHMEN TRANSFEREE

1. Application form duly accomplished with two (2) 2”x2”
colored recent photographs with a white background.
2. Original/Certified True Copy of the following:
A.) Transcript of Records (with General Weighted Average)
• Graduate with a Bachelor’s degree, and preferably earned
the following units:
a.1) 15 units of Biology (Botany, General Zoology,
General Biology, Parasitology, Physiology and
Vertebrae Comparative Anatomy);
a.2) 10 units of Chemistry (General Chemistry, Analytical
Chemistry, Organic Chemistry, and Bio-Chemistry);
a.3) 9 units of Mathematics (Algebra, Trigonometry,
Pre-Calculus, Calculus or Statistics);
a.4) 5 units of Physics (General Physics)
a.5) 12 units of Social Sciences
B.) Certificate of expected graduation.
C.) NMAT result (not lower than 90 percentile rank).
D.) Birth Certificate (NSO or PSA authenticated).
(If Married: Marriage Certificate)
E.) Two (2) Certificates of Good Moral Character from any of the
following: Dean, Guidance Counselor, Student Affairs, College
Secretary, or Registrar.
3. If a foreigner or foreign Graduate: Please refer to the SLMCCM-
WHQM website for application requirements for foreign students
and foreign graduate.
1. Application form duly accomplished with two (2) 2”x2”
colored recent photographs with a white background.
2. Original/Certified True Copy of the following:
• Transcript of Records (College and Medicine I)
• Certificate of Eligibility for Medicine (CEM)
• Transfer credentials
• Certificate of Ranking
• NMAT result (not lower than 90 percentile rank)
• Birth Certificate (NSO or PSA Authenticated).
(If Married: Marriage Certificate)
• Two (2) Certificates of Good Moral Character from any of the
following: Dean, Guidance Counselor, Student Affairs,
College Secretary, or Registrar.
3. Satisfy admission requirements set for regular 1st year applicants
4. Within the upper 20% of his/her batch.
5. No failure in any subject.
6. If a foreigner or foreign Graduate: Please refer to the SLMCCM-
WHQM website for application requirements for foreign students
and foreign graduate.

RESTRICTIONS ON ADMISSION
• Failure of more than Ten (10) units from the previous school.
• General Weighted Average (GWA) lower than 2.5 or its equivalent.

APPLICATION FEES

PROCESSING FEES (NON-REFUNDABLE)

APPLICANT October 1, 2018 to
March 29, 2019 onwards
March 29, 2019

LOCAL Php 3, 000.00 Php 3, 500.00

*FOREIGN / STUDENTS WHO GRADUATED ABROAD $ 300.00 $ 350.00

*Endowment of $10,000.00 (non-refundable) upon enrollment, towards SLMCCM-WHQM Institutional Development Fund.

SCHOLARSHIP ELIGIBILITY

Scholarships may be offered to graduates of colleges or universities with the following credentials, subject to the evaluation and approval
of the Scholarship Committee:
1.) NMAT percentile rank of 95% or higher.
2.) Magna or Summa Cum Laude.
3.) No failure in any subject.

ADDITIONAL REQUIREMENTS FOR ENROLLMENT

ORIGINAL copies of the following:

• Transfer credentials
• Official Transcript of Records with remarks “Graduated”

St. Luke’s College Medical Center of Medicine William H. Quasha Memorial

Sta. Ignaciana Street Cathedral Heights, Quezon City
Telephone Nos.: 727•7610 / 723•0301 local 3808
Email Address: registrar @stlukesmedcollege.edu.ph
website: www.stlukesmedcollege.edu.ph
 Be a Lukan M.D. Application Number
Date

2x2
APPLICATION FORM
St. Luke’s Medical Center College of Medicine (Doctor of Medicine Program)

NAME (Last Name, First Name, M.I.)

PERMANENT ADDRESS CITY

ZIP CODE

PLACE OF BIRTH RELIGION CIVIL STATUS

DATE OF BIRTH CITIZENSHIP GENDER AGE

TEL. NO. MOBILE NO. EMAIL ADDRESS

FATHER OCCUPATION CONTACT NO.

MOTHER OCCUPATION CONTACT NO.

GUARDIAN ADDRESS CONTACT NO.

EDUCATION
PRIMARY EDUCATION YEAR GRADUATED

SECONDARY EDUCATION YEAR GRADUATED

TERTIARY EDUCATION YEAR GRADUATED

PRE-MED COURSE YEAR GRADUATED

SCHOOL LAST ATTENDED SCHOOL YEAR

HONORS / AWARDS

*For those with a gap between graduation and medical school application please provide details.
Why St. Luke’s Medical Center College of Medicine? Please rank according to importance.
(1 = most important; 6 = least important)

Curriculum Scholarship Opportunity Facilities

Reputation Career Opportunity Others

Have you applied in other medical school(s)?

[ ]No [ ] Yes
School Status of Application

Have you ever been enrolled in other medical school(s)?

[ ]No [ ] Yes
School Date / School Year

Do you need financial assistance?

[ ]No [ ] Yes If Yes, please download financial aid application form at SLMCCM-WHQM Website.

IF FOREIGN APPLICANT: ACR No. VISA STATUS

IMPORTANT: The application for admission does not mean automatic acceptance to the St. Luke’s Medical Center College of Medicine.

I certify to the veracity of the above information, any evidence of fraud in the credentials/documents submitted will automatically nullify
my enrollment in the St. Luke’s Medical Center College of Medicine.

I certify further that if accepted, I will abide by all rules and regulations of the College and CHED.

OR No. Signature of Applicant

St. Luke’s Medical Center College of Medicine William H. Quasha Memorial
Sta. Ignaciana Street Cathedral Heights, Quezon City
Telephone Nos.: 727•7610 / 723•0301 local 3808
Email Address: registrar @stlukesmedcollege.edu.ph
website: www.stlukesmedcollege.edu.ph
 Be a Lukan M.D. Date

APPLICATION FORM
St. Luke’s Medical Center College of Medicine (Doctor of Medicine Program)

ESSAY

What skills and experiences do you have which will help you through medical school?

IMPORTANT: The application for admission does not mean automatic acceptance to the St. Luke’s Medical Center College of Medicine.

I certify to the veracity of the above information, any evidence of fraud in the credentials/documents submitted will automatically nullify
my enrollment in the St. Luke’s Medical Center College of Medicine.

I certify further that if accepted, I will abide by all rules and regulations of the College and CHED.

OR No. Signature over printed name

St. Luke’s Medical Center College of Medicine William H. Quasha Memorial
Sta. Ignaciana Street Cathedral Heights, Quezon City
Telephone Nos.: 727•7610 / 723•0301 local 3808
Email Address: registrar @stlukesmedcollege.edu.ph
website: www.stlukesmedcollege.edu.ph
 Be a Lukan M.D. Date

APPLICATION FORM
St. Luke’s Medical Center College of Medicine (Doctor of Medicine Program)

How did you come to know about this school? Are you being treated for any medical condition? Yes No

Open House If yes, what medications are your currently taking?

Internet

Med Talk

Others

DATA SUBJECT CONSENT FORM

In accordance with RA 10173 of Data Privacy Act of 2012, I consent to the following terms and conditions on the collection, use,
processing and disclosure of my personal data:

1. I am aware that St. Luke’s Medical Center College of Medicine-WHQM (“SLMCCM-WHQM”) has collected and
stored my personal data, defined under the law as referring to all personal information, in its database during
my application for admission in the Doctor of Medicine Program / Master of Science in Molecular Medicine
Program. These data include my academic records, demographic profile, contact details like addresses, email
address, landline and mobile phone numbers.

2. I will personally update these data upon request of SLMCCM-WHQM or as needed.

3. Towards the efficient management of the organization’s records, I authorize SLMCCM-WHQM, and its affiliate
offices including, but not limited to, the offices of the President and Dean, Associate Deans, and Guidance and
Counseling, to manage my data for data sharing with accredited industry partners and government agencies.

4. I agree to have my name posted in the website and bulletin board/s of SLMCCM-WHQM if I get accepted into
any of its academic program offerings.

5. To ensure the protection of my rights as a data subject, defined under the law as referring to an individual
whose personal, sensitive personal, or privileged information is processed, I understand that SLMCCM-WHQM
shall warrant to me the following rights:

a. Receive notices on changes in the above-cited purposes for my data processing or personal data breaches
provided for in Section 38 of the Data Privacy Act’s Implementing Guidelines;

b. Upon submission of a notarized letter of request, erase my personal data due to unauthorized processing or
when information is prejudicial to me;

By signing below, I warrant that I have read and understood all of the above provisions and agreed with its full implementation.

IMPORTANT: The application for admission does not mean automatic acceptance to the St. Luke’s Medical Center College of Medicine.

I certify to the veracity of the above information, any evidence of fraud in the credentials/documents submitted will automatically nullify
my enrollment in the St. Luke’s Medical Center College of Medicine.

I certify further that if accepted, I will abide by all rules and regulations of the College and CHED.

OR No. Signature over printed name

St. Luke’s Medical Center College of Medicine William H. Quasha Memorial
Sta. Ignaciana Street Cathedral Heights, Quezon City
Telephone Nos.: 727•7610 / 723•0301 local 3808
Email Address: registrar @stlukesmedcollege.edu.ph
website: www.stlukesmedcollege.edu.ph