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ENROLMENT Form Word Format

The document is an application form for Pacific Intercontinental College, requesting personal and educational information from prospective students. It includes sections for applicant details, program selection, and a non-discriminatory declaration. Additionally, it outlines the process for application withdrawal and the consequences of providing false information.

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Teacher Dani
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96 views1 page

ENROLMENT Form Word Format

The document is an application form for Pacific Intercontinental College, requesting personal and educational information from prospective students. It includes sections for applicant details, program selection, and a non-discriminatory declaration. Additionally, it outlines the process for application withdrawal and the consequences of providing false information.

Uploaded by

Teacher Dani
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

PACIFIC

Insert 2x2 Latest


INTERCONTINENTAL
Colored Picture
COLLEGE
“Transnational Education Provider”
Lot 20 Block 30, Silver Corner, Marble Road, Pilar
Village Las Piñas City Philippines 1750.

Email: pic1@[Link] Contact Number: (632)872-0773; 478.7710

Website: [Link]

Fill up the Application Form below with the correct details.


Applicant’s Information

Full Name: Last Name First Name Middle Name


Primary Email: Status:
Secondary Email: Gender:
Contact Number: Citizenship:
Place of Birth: Birthday:
Address:
City: Province:
Country: Philippines Zip Code:

PROGRAM YOU WANTED TO ENROLL


Degree Program: BACHELOR MASTER PHD
Preferred Major Study:/ /Educ'l Mgnt / / Math / / English / / Science / / ECE / / Computer Ed / /PE
Previous School Graduated:
Self-introduction :

Name of Recommender: Dr. Germelin M. Casao

By filling this form you certify that the foregoing information are true and correct to the best of your knowledge and you
fully realize the omission or falsification of any information will be considered sufficient reason for the rejection or
dismissal of this application.

NOTE: Students who withdraw their application must request a written withdrawal statement from the Registrar’s
Office by Registered Mail. Postmark on the envelope determines the date of cancellation. The refund percentage is
based on the total tuition fee for the degree program and not from the amount paid.

NON-DICRIMINATORY DECLARATION

Pacific InterContinental College admits students and faculty of any race, creed, color, national and ethnic origin to all
of the rights, privileges, programs, and activities generally accorded or made available to students at the Institute. It
does not discriminate on the basis of race, color, creed, national and ethnic origin in the administration of its
educational policies, admissions policies, scholarships and other school - administered programs.

Applicant’s Signature:

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