CCSFP Admission Form 001
City of San Fernando, Pampanga
Email:
[email protected] Application No:____________
APPLICATION FORM FOR FIRST YEAR
APPLICATION FORM FOR FRESHMAN
A. Y. 2024—2025 1.5 X 1.5
INSTRUCTIONS
1. Fill out all required information in this admission form. Colored Picture; white
2. Print all entries legibly and only fully accomplished forms (CCSFP-Admission Form 001) will be processed.
background w/ name
COURSE APPLIED FOR: tag
1st Choice - _______________________________________________________________________________
2nd Choice—______________________________________________________________________________
I. PERSONAL INFORMATION
Last Name First Name Middle Name
1. ____________________________________________________________________________________________________________
2. Age:_______ 3. Gender: ______________ 4. Date of Birth:________________________________________________
5. Place of Birth: ___________________________________________ 6. Marital Status: ________________________________
7. Contact Number/s: ________________________ 8. Religion: ________________ 9.Email Address: ___________________________
10. Complete Home Address: ______________________________________________________________________________________
11. Applicant is living with Relative: _________________________ 12. Address: ____________________________________________
II. SCHOLASTIC BACKGROUND
13. College: (Undergraduate)___________________________________________________ Course: _____________________________
School Address: _______________________________________________________ Last Sem/Year Attended: _______________
14. Senior High School (Grade 12): _______________________________________________ Year Graduated:______________________
School Address: _______________________________________________________ LRN #: __________________________
Awards/Honors Received: ___________________________________________________________________________________
15. Junior High School (Grade 10): _______________________________________________ Year Graduated: _____________________
School Address: _______________________________________________________________________________________
Awards/Honors Received: ___________________________________________________________________________________
16. Primary: _____________________________________________________________ Year Graduated: ____________________
17. Special Skills/Talents: ___________________________________________________________________________________________
18. Interest Sports/Affiliations: ______________________________________________________________________________________
III. FAMILY BACKGROUND
Name Occupation Employer /Employer’s Address
Father _____________________________________ ___________________________ _______________________________
Mother _____________________________________ ___________________________ _______________________________
Guardian _____________________________________ ___________________________ _______________________________
Guardian’s Address: __________________________________________________________ Contact Nos. ____________________
IV. MONTHLY FAMILY INCOME
₱ 219, 140 and above ₱ 76, 669 to ₱ 131, 484 ₱ 21, 914 to ₱ 43, 828 Below ₱ 10, 957
₱ 131, 483 to ₱ 219, 140 ₱ 43, 828 to ₱ 76, 669 ₱ 10, 957 to ₱ 21, 914
How did you know about City College? (Shade the circle of your answer)
Posted Tarpaulin Word-of-mouth Internet/Social Media Other (Please Specify): _____________________
TO BE FILLED OUT ONLY BY PERSONNEL AUTHORIZED TO RECEIVE AND / OR PROCESS APPLICANTS. (Check the submitted Documents)
Application Form F137 F138 CGMC 1.5x1.5 (4pcs)
PSA (Birth and Marriage) Elec. Bill (Latest 2 months Receipt) 2 Long White Folders
Received/Processed by: ___________________________________ Date: _________________________________
DATE OF TEST: _________________ TIME: ________AM _________ PM ROOM NUMBER: __________________
STUDENT IS PRESENT ABSENT
APPLICANT’S NAME: _________________________________________________________________________________________
DATE OF TEST: _________________ TIME: ________AM _________ PM ROOM NUMBER: _____________
APPROVED:
IRENE P. PINEDA
Registrar
SIBLINGS
Name Educational Attainment Occupation/ Employer/School Attending
_____________________________ ___________________________ ______________________________________________
_____________________________ ___________________________ ______________________________________________
_____________________________ ___________________________ ______________________________________________
_____________________________ ___________________________ ______________________________________________
_____________________________ ___________________________ ______________________________________________
_____________________________ ___________________________ ______________________________________________
_____________________________ ___________________________ ______________________________________________
_____________________________ ___________________________ ______________________________________________
_____________________________ ___________________________ ______________________________________________
_____________________________ ___________________________ ______________________________________________
I am aware that any of all the information furnished in this applica- I recognize that in signing this application form, I share with my
tion may be checked against the original documents and the with- child/dependent the responsibility for the veracity and complete-
holding or giving false information will disqualify me from admis- ness of the information supplied herein.
sion or will be a basis for dismissal, if admitted.
_______________________________________
_______________________________________
Signature of Parent/Guardian
Signature of Applicant
__________________________
__________________________
Date
Date
(PLEASE DO NOT WRITE BELOW)
ENTRANCE TEST RESULTS
Test Given Raw Score Percentile Rank Stanine Score (SS) Verbal Interpretation
SCHOLASTIC ABILITY TEST FOR ADULTS ___________ _____________ _______________ ______________________
Remarks:
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________.
_______________________ ________________________
Psychometrician Guidance Counselor
