PHILIPPII\E NATIONAL POLICE ACADEMY

CADET ADMISSION TEST APPLICATION

BODY MASS INDEX FO.RM

(To be accomplished Ev a Government Phvsician/Reqistered Nurse)

Name:
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trlk 2s LoT t 6 Pttrce t, (N BtotlD tlx.
Address:

9ryl'lLr, C*6ul frO A fy ,1 3 :,', t

Age: I fl years old upon application

Height: 172'{ in cm (Bare Foot)

Weight: tl.\f in kgs.

Sex: fr Male I Female

Normal Obese I

BMI

[funderweisht I Obese ll

I-l overweisht
I HEREBY CERTIFY that I personally exami ned the above-named applicant, to determine
his/her height and weight measurement.

ral@4 LO'JELY

/rcql
-t;ffi**d Name & n/Nurse License No.

Name of Hospital/Clinic: 0W ccolh<

W1,1 s, OfVWn, LllOrnO
Contact No.