HEADQUARTERS

DEPARTMENT OF MILITARY SCIENCE AND TACTICS

PAMANTASAN NG LUNGSOD NG VALENZUELA ROTC UNIT (P)
1301ST CDC, NCRRCDG, ARESCOM
Tongco St. Maysan, Valenzuela City

ROTC REGISTRATION FORM

(Print all Entries)

Student No: ________________________ MS: _____2______ Date: ____________________

Name: ______________________________________________________________________
(Last Name) (First Name) (Middle Name)
Temporary Address: (Don't fill up if you have your permanent address.)
No/St/Bill/Brgy: __________________________________________________________
Municipality: ____________________________________________________________
Province: ______________________________________________________________
Sex: M (_) F (_) Religion: __________________ Tell/Cell No: ___________________________
Course: ____________________________ Yr & Section: __________ School:PLV (_) VPC (_)
Age: _____ Date of Birth: ________________________ Place of Birth: ___________________
Height: _________ Weight:: _______________ Complexion: ____________ Blood Type: _____
Permanent Address:
No/St/Bill/Brgy: __________________________________________________________
Municipality: ____________________________________________________________
Province: ______________________________________________________________
Father: _____________________________________ Occupation: ______________________
Mother: ____________________________________ Occupation: ______________________
Person to be notify in case of emergency:
Name: ______________________________________ Relationship: _____________________
Address: __________________________________________ Tell/cell No: _________________
Military Science Completed:
MS SEMESTER SCHOOL YEAR GRADE REMARKS
____________ __________ _____________ ______ ___________
____________ __________ _____________ ______ ___________
____________ __________ _____________ ______ ___________
____________ __________ _____________ ______ ___________

Are you willing to take the advance course? ( ) Yes ( ) No

(Signature of student)

_______________________
_______________________
(Commandant)

HEADQUARTERS
DEPARTMENT OF MILITARY SCIENCE AND TACTICS
PAMANTASAN NG LUNGSOD NG VALENZUELA ROTC UNIT (P)
1301ST CDC, NCRRCDG, ARESCOM
Tongco St. Maysan, Valenzuela City

Date:
CERTIFICATION

TO WHOM IT MAY CONCERN;

THIS IS TO CERTIFY that ___________________________ College ____________

(Full Name) (Course and Section)
is duly registered in the Military Science (1) of Reserve Officers' Training Corps (ROTC)
Program for the (1st) Semester, School Year (2022-2023).

Certified by:
_______________________
_______________________