a ran ria COLLEGE ADMISSION d —— APPLICATION FORM ‘TO THE APPLICANT: PRINT legibly all information required, Put V marks in appropriate boxes. Only correctly and completely filed-out form will be accepted for processing. PROGRAM COURSE: DATE OF APPLICATION: NAME OF APPLICANT: mrecrope you ht amet long sogerce: LAST NAME FRET NAME ans MOL NAME Pace re rin nh bot Lan one ot nk eee aes, LAST FIRST MIDDLE 43, Date of Birth: . . 7. Religion: 4, Place of Birth: 8. Citizenship: s.800 Female 9. Mobile No. 6. Civil Status: Single maried [|] widower [_] 10. Emait addres: “1, Permanent Address: 12, Postal Code 43. Father: 14, Mother: 45. Guardian ‘Occupation: Occupation: ‘Occupation: ‘Company & Address: ‘Company & Address: ‘Company & Address: Contact NoJs: Contact Nos ‘Contact Nos 16. Average Family Income (Monthly) Please check one: —100000bew |] 20,001-20.000[] 20001 - 40000[] 40.001 -so000[] 50,001-10.000[] 100.001 above [] 417. Senior High School Track: 18. Collogo (if any)/ALS GRADUATE, 48, Momber of Cultural Minority Group? Yes SHS Name. ‘Schoo! Name No Do you have any physical disability or condition that requires special attantion? No Yes tncernebame ere | etme agra (Specify atached certcaion of asi) (ros am fly amare tht Keli ng Lungsodg Lipa is obigted under he Data Privacy Act of 2012 ands mperanting Rules an Regulatons (RR) efecive ‘nce Soptemter 8, 2016, to protect a my personal nd sonsttveinfraton hat cles, processes, and etans upon ry appcaon fr admission, eon ad ‘ling my slay nthe Cologe Lkewise am fy aware that KLL ray share such termaton to alle o parte organzsbons as pa ols contarua otigairs, ‘or win goverment agoncios pursuant o aw or gal preceses. nthe agar, hereby all KL to coe, poset, use and hare my personel data inthe pursut of [slegimate academe reseaich and emcoymnent purposes and netess as an ection! ston. Cr) ‘herby catty that infomation supped this arelcation lm is compete and acctete | so understand tha any fale infomaton wil cualiy me fom boing anitedto te Colege, Date ‘Signature of Applicant Date Signature of ParentGuardian a ee tte a