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Registration For Enrollment Form

This document contains forms for new, continuing, and returning students to fill out for registration at Don Mariano Marcos Memorial State University. The forms request information such as name, program/course, requirements, and student information. Requirements include original and photocopied documents like an honorable dismissal, birth certificate, transcripts, and ID photos. The student information section asks for details such as address, education history, occupation, exam results, references, and a certification that the information is true.

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Reno Estero
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111 views1 page

Registration For Enrollment Form

This document contains forms for new, continuing, and returning students to fill out for registration at Don Mariano Marcos Memorial State University. The forms request information such as name, program/course, requirements, and student information. Requirements include original and photocopied documents like an honorable dismissal, birth certificate, transcripts, and ID photos. The student information section asks for details such as address, education history, occupation, exam results, references, and a certification that the information is true.

Uploaded by

Reno Estero
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Don Mariano Marcos Memorial State University

OPEN UNIVERSITY SYSTEM


San Fernando City, La Union
www.dmmmsu.edu.ph
(072) 242-3608
[email protected]
https://www.facebook.com/DMMMSUOpenUniversity

____ New student


Latest 2x2
____ Continuing student I.D. picture
____ Returning student REGISTRATION FOR ENROLLMENT FORM (with name tag in
white background)
____ Cross-enrollee

Name: ______________________________________________________________________________________________________
(Family name) (First name) (Middle name)
Program/Course: ______________________________________________ Major: _______________________________________
Mode of Learning: ( ) Group Paced ( ) Self-Paced ( ) Online, name of country: _______________________________
( ) First Semester ( ) Second Semester ( ) Midyear Term School Year _____ to _______

REQUIREMENTS: Original and photocopy/scanned of the following documents

Honorable Dismissal/Transfer Credential PSA Birth Certificate 3 pieces long folder


Official Transcript of Records Medical Certificate with Chest x-ray Certificate of Grades for continuing & returning student
Senior High School Report Card/Form 138 College Admission Test Result 6 pcs. 2X2 I.D. picture with name tag in white backgd
Certificate of Good Moral Character Permit to cross-enroll

Checked by:
________________________________ _____________________________
Admission Officer Program Chairperson
Date of Registration: _________________________

STUDENT INFORMATION SHEET


Name: _______________________________________________________________________________________________
(Family Name) (First Name) (Middle Name)
Date of Birth:_________________ Place of Birth:_____________________________________Age:_____ Gender: _____
Permanent Address: ___________________________________________________________________________________
Contact number: ____________________________ Email address: ____________________________________________
Name of Parents:
a) Father ____________________________________ Occupation ____________________________________
b) Mother ___________________________________ Occupation ____________________________________
Civil Status: __________________________ Citizenship: ________________________
Name of spouse:_______________________ Occupation: ________________________ Number of Children:_________
EDUCATIONAL BACKGROUND:
(Name of School and Address) (Program/Course) (Year Graduated)
Elementary _________________________________________________________ _______________ _____________
Secondary __________________________________________________________ _______________ _____________
College ____________________________________________________________ _______________ _____________
Master’s Degree _____________________________________________________ _______________ _____________
Doctorate Degree ____________________________________________________ _______________ _____________
Others, please specify (e.g. tech-vocational skills) _________________________________________________________

OCCUPATION/EMPLOYMENT:
Position Employer/Address Date of Brief Description of Duties
(Please specify) (Please specify) Employment
__________________ ______________________________ ___________ ________________________________
__________________ ______________________________ ___________ ________________________________

Availability of internet connectivity:


( ) Home with LIMITED internet connectivity ( ) Workplace with LIMITED internet connectivity
( ) Home with STABLE internet connectivity ( ) Workplace with STABLE internet connectivity

PROFESSIONAL EXAMINATION TAKEN:


Title of Examination Date Taken Place of Examination Rating
_______________________________ ______________ __________________________________ ______________
Name and Address of at least two (2) uninterested parties from whom the Open University System can refer to about your
personal circumstances.
Name 1:___________________________________ Address: _________________________________________________
Name 2:___________________________________ Address: _________________________________________________

This is to certify that all the above information is true and valid.
Signature over Name of Student

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