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Assumption College San Lorenzo Drive
San Lorenzo Village
Telephones
817-7773 telefax
Makati City 1223 817-0757 loc. 2050

APPLICATION FOR ADMISSION AF 2005 1x1

School Year PHOTO

NAME
Instructions: ALL SECTIONS MUST BE
COMPLETED. Please print boldly using block LAST FIRST MIDDLE
letters. Write NA on the space when an item is not ADDRESS
applicable. Do not leave any item unanswered.
STREET NO. STREE VILLAGE/BARANGGAY
Affix signatures on indicated spaces. Failure to do
so can delay processing of your application. The
status of application cannot be determined without CITY PROVINCE ZIP CODE
the accomplished recommendation form and TELEPHONE MOBILE
required records. Application forms are processed
on a first come first serve basis so make sure
compliance with all application requirements is EMAIL ADDRESS
completed as soon as possible.

FOR OFFICIAL USE. DO NOT WRITE BELOW THIS LINE.

COURSE MAJOR

TESTING DATE STUDENT NO.

OR No. OR Date OR Amount

ACET S AP RF BA
1
0 1 En Academic Honors

2 Fil Interrupted
V % 2 3 GC
3 Schooling
4 5 Ma
Q % P/D
4 Repeater
6 7 Sc

TR % So
Failures
8 9
GPA

Pts Pts Pts Pts Pts

TOTAL RATING

ACTION TAKEN Automatic Acceptance Automatic Reject For Reconsideration

TYPE F T S STATUS Regular Probationary Reject

English Enrichment/Date Math Enrichment/Date Both /Dates

A PERSONAL INFORMATION

01 Date of Birth Month Day Year

Place of Birth

02 Religion Roman Catholic Other, specify

03 Citizenship Filipino Alien, specify

04 Civil Status Single Married Separated Widowed Divorced

FOR NON-FILIPINOS AND FILIPINOS BORN ABROAD

05 Immigration Status/Visa Classification Country Issuing Passport

06 Passport No. Date Issued Place Issued

Month Day Year

07 ACR No. Date Issued Place Issued

Month Day Year

FAMILY BACKGROUND

08 Name of Father
Last First Middle

Living? Yes No Citizenship Filipino Alien, specify

Address Home Telepone No.

Email address Mobile telephone No.

Highest Education Attainment Business/Occupation

Company Name Position

Business Address BusinessTelepone No.

09 Name of Mother
Last First Middle

Living? Yes No Citizenship Filipino Alien, specify

Address Home Telepone No.

Email address Mobile telephone No.

Highest Education Attainment Business/Occupation

Company Name Position

Business Address BusinessTelepone No.

10 Name of Guardian
Last First Middle

Living? Yes No Citizenship Filipino Alien, specify

Address Home Telepone No.

Email address Mobile telephone No.

Highest Education Attainment Business/Occupation

Company Name Position

Business Address BusinessTelepone No.

 For Married Applicants

11 Name of Spouse
Last First Middle

Date of Birth Month Day Year

Citizenship Filipino Alien, specify

Address Home Telepone No.

Email address Mobile telephone No.

Highest Education Attainment Business/Occupation

Company Name Position

Business Address BusinessTelepone No.

12 Do you have relatives who graduated or study in Assumption? Yes No If yes, specify

Name/Relationship Year Graduated/Study Department (GS, HS, College) Location

13 Siblings (brothers and sisters) Yes No If yes, specify

Name/Level?Position Age School/Office Grade/Year

14 Have you ever been pregnant? Yes No 15 Are you pregnant now? Yes No

16 Do you have children? Yes No If yes, specify

Name Age School Grade Level

B ACADEMIC BACKGROUND

01 Present/Last School’s Offficial Name

02 School Address 03 Telephone No.

04 Principal/College Dean 05 Guidance Counselor

06 Schools Attended Address Year Graduated

Grade School

High School
 For Transferrees If you were at any one time enrolled in a certificate or degree course, please fill up this segment.

07 Have you ever applied at the Assumption College in the past? Yes No

If yes, Year and Course applied Reason for leaving

08 Colleges/Universities attended Address Course Year attended

ACADEMIC HONORS AND DISTINCTIONS

09 Please list all academic honors, distinctions, awards earned. Use a separate sheet of paper if necessary.

Honor/Award Year Level Event

10 Are you a candidate for Class Valedictorian, Salutatorian, or Honorable Mention? Yes No

If yes, please specify.

Please submit a photocopy of your Certificate of Merit to the Admissions Office as soon as you receive it.
DISCONTINUANCE OF STUDY

11 Did you ever have to stop studying? Yes No If yes, please provide the details below.

School Year/Reason(s)

ACADEMIC PROBLEMS

12 Did you fail in any subject(s) in high school/college? Yes No

If yes, please provide the details below. (Tranferrees must include undergraduate courses.) Use separate shee of paper, if necessary.

Subject Grading Period Year Level Reason for failure

13 Did you ever have to repeat a year in high school? Yes No If yes, please provide the details below.

Year Level Subjects failed Reason for failure

 DISCIPLINARY RECORD

14 Were you ever placed on probation, suspension, or expelled from school? Yes No

If yes, please provide the details below. (Tranferrees must include undergraduate courses.) Use separate shee of paper, if necessary.

Offense Penalty Period Covered

15 Were you ever expelled or refused enrollment from your high school, college or university? Yes No

If yes, please specify.

C ACTIVITIES
01 List all activities, jobs, and interests outside of class. Transferees must include college activities. Please include positions held an other
special responsibilities. Use an additional sheet if necessary. Mark SR for school related, NSR for non-school related.
Activity or Organization Year Level Number of hours involved per day/week/month

02 Have you ever been elected/appointed as class officer? Yes No

If yes, please specify.

03 Do you currently (or in the past) have a modelling contract? Yes No

If yes, please specify.

D COLLEGE APPLICATION

01 In order of preference, please list colleges or universities you have applied to or intend to apply to.

College/University Course Have you taken entrance test?

02 Please rank (1 being the highest) top 5 factors which helped in choosing Assumption College.
Academic Character/Values Flyer/Brochure/
Excellence Womens’ College formation Poster AC Graduate
High school
Family Security College Fair counselor Location
Assumption
Friend Career talk/visit Parents’ choice Courses Prestige

AC Student Newspaper ad Career opportunities after Others

graduation
03 Please rank in numerical order the top 3 course preferences offered by Assumption College

04 Why did you select your most preferred course?

05 Who decided on your course/study in Assumption?

E EMERGENCY INFORMATION

Please provide the name of a contact person other than your parents whom the Admissions Office can call.

Person to notify LAST FIRST MIDDLE

Relation to you Aunt/Uncle Brother/Sister Grandparent Other

Home Address

Home phone Business telephone Mobile

F AGREEMENT
The following must be read and signed by the applicant and her parent(s), guardian, or spouse.

I understand that my application and admission into the Assumption College are subject to the following conditions:
1. That it is the responsibility of the applicant to provide all necessary documentary evidence of her qualification and experience;
2. That confidential recommendations, interview reports, and statements from members of the Admissions Committee and the Admissions
staff will be used solely for purposes of evaluation of this application;
3. That contents of confidential appraisals shall not be disclosed to me and members of my family.
4. That credentials filed in support of this application which are received by the Admissions Office become the property of the Assumption
College and will not be returned to the applicant;
5. That all forms distributed by the Admissions Office to elicit information are the property of Assumption College and therefore recognize
Assumption College’s property and confidentiality rights to the same;
6. That I have provided accurate information in this application, and authorize the verification of my credentials;
7. That any misrepresentation or omission of facts in my application will justify the denial or cancellation of admission;
8. That I will notify the Admissions Office of any change in status stated in this application and supporting documents from date of application
to date of formal admission into the College;
9. That I agree to comply with the rules, policies, and regulation of the Assumption College when I am accepted.

DECLARATION
I have read and understood all sections of this admissions package. I declare that to the best of my knowledge the information supplied in this
application and the documentationsupporting it is correct and complete.

Signature of Applicant Date 1x1

PHOTO

Signature of Parent/Guardian/Spouse Date