Army Vision: “By 2028, a world-class Army that is a source of national pride”

HEADQUARTERS
ADVENTIST TECHNOLOGICAL INSTITUTE ROTC UNIT
903rd (MOC) COMMUNITY DEFENSE CENTER, 9TH RCDG, ARESCOM
Dicoloc Jimenez, Misamis Occidental

OLT-ROTCUX ________________
(Date)
ROTC REGISTRATION FORM
(Print all Entries)

Student No.________________________ MS: _________________ Date:

Name: __________________________________________________________________
(Last Name) (First Name) (Middle Name)

Permanent Address:
Barangy: ________________________
Municipality/City: ___________________________________
Province: ______________________________________
Telephone/Cell Number: ___________________________________
Course: _______________School: ________________ Religion: ___ Sex:
Date of Birth: _________________ Place of Birth: _______________________________
Height: ___________ Weight: __________ Complexion: ____________ Blood Type: ____
Father: ____________________________________________ Occupation: ______
Mother: ____________________________________________ Occupation: ___________

Person to be notified in case of emergency:

Name: _________________________________________ Relationship: ____________
Address: _______________________________________ Tel No/ Cell Number:____________
Military Science Completed:
MS SEMESTER SCHOOL YEAR GRADE REMARKS
__________ _____________ __________________ __________ ____________
__________ _____________ __________________ __________ ____________
__________ _____________ __________________ __________ ____________
__________ _____________ __________________ __________ ____________
__________ _____________ __________________ __________ ____________
Are you willing to take the Advance Course?( ) Yes ( ) No

________________________
(Signature of Student)
______________________
Commandant
===================================================
HEADQUARTERS
ADVENTIST TECHNOLOGICAL INSTITUTE ROTC UNIT
903rd (MOC) COMMUNITY DEFENSE CENTER, 9TH RCDG, ARESCOM
Dicoloc Jimenez, Misamis Occidental
OLT-ROTCUX
________________

(Date)
CERTIFICATION

TO WHOM IT MAY CONCERN:

THIS IS TO CERTIFY that ___________________________ College ____________
Is duly registered in the ROTC program for the Semester,
School Year . __________________
Commandant

Army Core Purpose: Serving the people, securing the land.