[QF-ASR-027]

MANILA CAMPUS
1113-1117 San Marcelino Street
Paco , Manila, Philippines
Telephone: (632) 521-2710 loc. 6535/5371
Telefax: (632) 521-2710 loc. 5371
Email: [email protected]
Website: www.eac.edu.ph
2x2
CAVITE CAMPUS
Congressional East Avenue Burol Main
City of Dasmariñas, Cavite, Philippines
Telephone: (046) 416-4341to 42 loc. 106
Email: [email protected]
Website: www.eac.edu.ph/cavite
COLLEGE APPLICATION FORM
Application is made for:
Degree/Certificate Program: BACHELOR OF SCIENCE IN NURSING Filipino Foreign
Term: 1st Sem 2nd Sem Summer Academic Year: 2019-2020
Classification: Freshman Transferee
Second Courser Cross-Enrollee

I. PERSONAL INFORMATION
Last/Family Name: First Name: Middle Name: Learner's Reference No. (LRN):
CABER KRISCHELLE DAWN VILLEGAS 136698060048
Gender: Religion: Citizenship:
FEMALE Roman Catholic FILIPINO
Date of Birth: Place of Birth: Age:
2000-09-12 CALBAYOG CITY, WESTERN SAMAR 19
Apartment Name/ House No/ Street/ Barangay:
265, T. ALONZO ST., WEST REMBO
City/Municipality: Country: Zip code:
MAKATI CITY PHILIPPINES 1215
Civil Status: Single Married Widowed Divorced Maiden Name (If Married Female):

Mobile No: Email: Facebook: Twitter:

09957583721 [email protected] @PICK.EL.92 @PICKELLES

I.I. ALIEN STATUS INFORMATION (For Foreign student only)

Visa Status: Period of Authorized Stay:
0000-00-00
Passport No: Place of Issue: Exp. Date:

ACR No: Date of Issue: Exp. Date:

CRT No: Date of Issue: Exp. Date:

II. EDUCATIONAL BACKGROUND

School Level School Type School Name School Address Year General
Graduated Average
Elementary:
Public West Rembo Elementary School 21 A. MABINI ST., MAKATI 2013 0.00
Junior High School:
Public Fort Bonifacio High School J.P. RIZAL EXTENSION, MAKATI 2017 0.00
Senior High School:
Private Centro Escolar University GIL PUYAT, MAKATI 2019 93.94
College/University &
Degree: Private Centro Escolar University GIL PUYAT, MAKATI N/A 0.00
Graduate School &
Degree: Private 0.00

III. FAMILY INFORMATION

Father's Name: Mother's Name:
CABER, MA. RICHEL, VILLEGAS
Home Address:

Affliation:
N.A.
Occupation:
HOUSEWIFE
Deceased:
Yes No
Mobile No:
7205751
Company Name and Address:
N/A
Highest Educational
Attainment: COLLEGE GRADUATE
IV. SIBLINGS
No. of Siblings: No. of Brothers: No. of Sisters:
1 1 0

V. EMERGENCY CONTACT
Name Relation
SAMUEL CABER FATHER
Home Address Contact No.:
264 BLK 8 T. ALONZO ST. WEST REMBO, MAKATI CITY 09285655435
Monthly Income of Parents: Living Arrangement: Source of Financial Support:
More than 10,000.00 but less that 15,000.00 Living with Both Parents Parents

VI. OTHER INFORMATION

I learned about EAC through: (Please tick all that apply)

EAC Representative who visited our school for Career Fair/Career Talk

EAC Facebook

EAC Website

Brochures/Flyers/Posters/Banner/Tarpaulin

Referral from a friend (student) from EAC

Referral from EAC Employee

Referral from EAC Alumnus

My Parents/Relatives

Others

Reasons for applying at Emilio Aguinaldo College

Choose the three main reasons and rank according to importance, 1 being the most important:

1st Reason: Good Academic Reputation

2nd Reason: High Passing Rate in board exams
3rd Reason: Modern facilities

VII. CERTIFICATION
TERMS OF REFERENCE:
I hereby attest to the completeness and accuracy of all information supplied in this form. I understand that withholding of information or giving
false information may nullify my application for admissions or may jeopardize my continued stay after admission has been granted.

TERMS OF REFERENCE:
By choosing 'I Accept' below, I voluntarily agree to the Emilio Aguinaldo College (EAC) Privacy Policy and declares that:

I am of legal age.
I am confirming that all the information I provide are true and correct.
I understand that withholding of information or giving of false information may nullify my application for admission or may jeopardize my
continued stay after admission has been granted.
I am giving my consent to the collection, use, processing, recording, storage, blocking, destruction, and disclosure of the information I provided
for legitimate purposes in order to administer and evaluate the eligibility of my application for admission at EAC.

Note: The accomplished Application Form should be printed, signed by the applicant, and submitted to the EAC Admissions and Student Recruitment Office.

I agree with the terms of references.

CABER, KRISCHELLE DAWN V. December 26, 2019

Signature over Printed Name of Applicant Date