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Republic of the Philippines

MARINDUQUE STATE COLLEGE


National Service Training Program
Civic Welfare Training Service
Main Campus: Boac / Branches: Santa Cruz • Torrijos • Gasan
Panfilo P. Manguera Sr. Rd., Tanza, Boac, Marinduque 4900
Tel. No.: (042) 332-2028/2028 Email Address: sucpresident.msc@gmail.com
Trunkline: (042) 332-0662 Website: www.marinduquestatecollege.edu.ph

NSTP-CWTS TRAINEE REGISTRATION SLIP


Academic Year 2023-2024

To be filled-up by the STUDENT:


Passport Size
Picture

I. Date of Registration:______________________________________________ Second Semester, A.Y 2023-2024


Month Day Year
II. College of _____________________________________ Program/Major:__________________________________
III. Printed Name:

Last
Name

First
Name

Middle
Name

Date of Birth: ________________________________________ Home Address:____________________________________


(Month, Day, Year) (Street, Barangay, Municipality, Province)
Civil Status:_______________________ Age:______________ Sex:__________________
Mobile Number/Contact No:___________________________ FB Messenger Account
Name:_________________________
E-mail Address:________________________________________________________________________________________
Religion:___________________________ Height:_____________ Weight:_____________ Blood Type:_________________

IV. Person to be notified in case of emergency:___________________________________________________________


Relationship:___________________________________
Address:________________________________________________
Telephone/Mobile No:____________________________________

V. Skills:______________________________________________________________________________________________

VI. Training Requirements Submitted (Please check if submitted and complied)


______ Parent’s/Guardian’s Consent and Waiver for In-Campus and Other Local Off-Campus Activities
______ Student Accident Group Insurance (Photocopy of Issued ID or Proof of Payment)

_______________________________________ _______________________________________
Signature of Registering Officer Signature Over Printed Name

Vision: An advanced and adaptive university pursuing quality education, lifelong gender-sensitive learning environment, responsive research-based community programs
and transparent governance with sustainable resource generation by 2025.

Mission: To provide excellence in instruction, research, extension and production that magnifies WISDOM in leadership through Total Quality Management System
responsive to the challenges of the 21st century education.

Educating People, Enriching Lives and Expanding Opportunities with WISDOM!

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