V E L E Z C O L L E G E Please attach a

F. Ramos Street, Cebu City, Philippines 2X2 colored ID

Control No:____ Tel. No: (032) 253- 2018; Email: velezadmission@gmail.com picture with white
________
background and
STUDENT APPLICATION FORM nametag

Degree/Program applying for: 1st choice _______ 2nd choice_______ Date of Application:_________________

I. Personal Data
Name: ________________________________________________________________ ____________
(Surname) ( First Name) ( Full Middle Name)

Nickname: ___________________ Citizenship: ___________ Sex: Male Female

Birth Date: _ Birthplace: ________________ Age: _____ Civil Status: ______
mm / dd / yr

Birth Order: Nationality ________ Phone #: (Home) ________ Mobile: __________ E-mail:_____________
Address: __________________Home Address: _____ Zip Code: ______
Current Mailing Address: ________________________________________________________ Zip Code: ______
Languages/ Dialects Most Fluent In______________________________________Religion: _______________
II. Home and Family Background
Father (Mark with + if deceased) Mother (Mark with + if deceased)
Name
Date & Place of Birth
Current Address
Citizenship
Landline # / Cell phone #
Email Address
Highest Educational Attainment
Occupation
Company Name & Address
Annual Income(optional)
Language/s Spoken
Current Religion

Parents: (Check all that applies)

Living together Father OFW
Permanently separated Mother OFW
Temporarily separated _ Father w/ another partner
Marriage annulled/ Legally Separated Mother w/ another partner
Guardian (if not living with Parents): _________________ Relationship with guardian: ______
Address: _____________________________________________________________________________
Landline #: Cell phone #: _______________________ Email Address: ____________

Please list down the name/s of your sibling/s from eldest to youngest.
Name of Siblings School/Place of Work Age

Office of Student Services and Affairs /Admission Office /SAF2019/

III. EDUCATIONAL BACKGROUND
Grade/Year Level Name of School Inclusive Year of Attendance Award/s Received

Membership in Organizations:
Name of Organization Position Years active

IV. HEALTH
Disabilities/Impairments_______________________ Chronic Illness________________________________
Medicines Regularly Taken _____________________ Vitamins Regularly Taken _______________________
Accidents Experienced:___________________ _____ Operations Experienced:________________________
Check (/) Immunizations you have had:
____ Chicken Pox _____ Measles (MMR) ____ Mumps ____Small Pox ____ Booster
____ Hepatitis B _____ Influenza ____ Others (pls. Specify)__________________
Previous Psychological Consultations
Have you consulted a psychiatrist before? No__ Yes__ If yes, when? ____________________________
For how many sessions? How long? ________________ For what? ____________________________
Have you consulted a counselor before? No___ Yes__ If yes, when? ___________________________
For how many sessions? How Long? ________________ For what? ____________________________

V. OTHER INFORMATION
A. Has there been a time that you stop attending school? Yes No
If Yes, state reason:_____________________________________________________________________
Did you choose this course yourself? Yes No
If Yes, state reasons for your choice: ____________________________________________________
If No, what influenced you in making the choice? ___________________________________________
B. What do you think could be a possible obstacle/s to pursue your studies? __________________________
________________________________________________________________________________
C. Reason for choosing Velez College (Please check all that applies)
School offers good training Tuition is more affordable Most of my friends are in Velez
School’s academic reputation Graduates have better career opportunities Others, please specify,
Want to be closer to home Accessible by any means of transportation ______________________

I hereby certify that all entries herein are true and correct.

_______________________
Signature over Printed Name

**Information revealed is held confidential.**

Office of Student Services and Affairs /Admission Office /SAF2019/