University of San Agustin

General Luna St., 5000, Iloilo City Philippines

www.usa.edu.ph

COLLEGE OF NURSING, NUTRITION AND DIETETICS

NURSING DEPARTMENT

AGREEMENT

Date _____________________________

To Whom It May Concern:

I _________________________________________________________________, a resident of
______________________________________________________________________________
in consideration of my enrollment in the University of San Agustin – College of Nursing,
Nutrition and Dietetics – Nursing Program, hereby agree to comply with the following
terms:

1. That I shall abide by the rules and regulations which the competent authorities of this
University have issued, particularly those embodied in the University of San
Agustin–Nursing Program Student Handbook, or those which they may henceforth
issue;

2. That I shall be of good moral character and shall conduct myself in a proper and
irreproachable manner in my relation with the school authorities and fellow students;

3. That I fully understand the conditions set forth, and should I fail to observe any one
of them, the school authorities have the right to suspend or expel, or otherwise,
refuse to admit me to the University of San Agustin – College of Nursing, Nutrition
and Dietetics–Nursing Program.

_____________________________________
Signature of Student

_____________________________________
Student’s Name in Print

A Legacy of Excellent Education in Virtus et Scientia

Email: cnnd@usa.edu.ph | Contact No.: 0939-278-9080