UNIVERSITY OF THE EAST

RAMON MAGSAYSAY MEMORIAL MEDICAL CENTER, INC.

#64 Aurora Boulevard, Barangay Doña Imelda, Quezon City 1113, Philippines
Telelefax: (632) 713-3315; (632) 715-0861 Local 261
Email Address: [email protected]; Website: www.uerm.edu.ph

OFFICE OF THE REGISTRAR

COLLEGE OF MEDICINE
INFORMATION SHEET FOR FILIPINO AND RESIDENT ALIEN
SCHOOL YEAR, 2011-2012

I. REQUIREMENTS FOR APPLICATION:

a. Original Transcript of Records
b. Certified copy of AB/BS Diploma/Certificate of Candidacy for Graduation
c. Original Certificate of Good Moral Character from two former professors
d. National Medical Admission Test (NMAT) Result
PREFERRED NMAT: 70%ile
VALID NMAT: April & December 2008; April & December 2009; April & December 2010
e. Birth Certificate authenticated by NSO
f. Marriage Certificate, if married
g. 2x2 Pictures ( 2 Pieces Colored White Background)
h. Application and Processing Fees: Php1,200.00(NON-REFUNDABLE/NON-TRANSFERABLE)

II. DEADLINE FOR SUBMISSION OF APPLICATION: DECEMBER 22, 2010

List of Accepted Applicants will be posted on the Bulletin Board of the Office of the Registrar.

III. MINIMUM REQUIREMENTS:

1. Applicant must be a holder of a Bachelor’s Degree in Science or Arts.
2. Applicant will be scheduled for an interview upon submission of accomplished application
form.
3. Applicant must have taken the National Medical Admission Test (NMAT)

For NMAT inquiries, please write or call to:

CENTER FOR EDUCATIONAL MEASUREMENTS

24th Floor Cityland Pasong Tamo Tower
2210 Chino Roces Avenue, Makati City, Philippines
Tel. Nos.: (632) 894-5536, (632) 813-3686, (632) 813-3691, (632) 813-3694 to 95 loc. 106

IV. REQUIREMENTS FOR ENROLLMENT:

Upon acceptance, the following are required for submission:

a. Complete Official Original Transcript of Records
b. Certificate of Graduation / Copy of Diploma (disregard if submitted already)
c. Transfer Credential Certificate / Honorable Dismissal Certificate
d. Original NMAT Result
e. Alien Certificate of Registration (ACR) issued by the Bureau of Immigration
f. Miscellaneous Foreign Fee (For Resident Alien) - $10,000.00 – NON-REFUNDABLE

NOTE:
THE SCHOOL HAS NOT AUTHORIZED ANY PERSON/AGENCY OR ORGANIZATION TO WORK ON BEHALF OF
ANY APPLICANT FOR ADMISSION.

THE ADMISSIONS COMMITTEE WILL NOT PROCESS ANY APPLICATION SUBMITTED OR FOLLOWED UP BY
THIRD PERSON.

ALL INQUIRIES, REQUESTS AND DOCUMENTS MUST BE ADDRESSED DIRECTLY TO THE OFFICE OF THE
REGISTRAR.

ALL DOCUMENTS FILED IN SUPPORT OF THE APPLICATION BECOMES THE PROPERTY OF THE
UNIVERSITY OF THE EAST RAMON MAGSAYSAY MEMORIAL MEDICAL CENTER, INC. AND WILL NOT BE RETURNED
TO THE APPLICANT.

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 UNIVERSITY OF THE EAST Apl. No.: ______________
RAMON MAGSAYSAY MEMORIAL MEDICAL CENTER, INC. O.R No.: ______________
Aurora Boulevard, Quezon City 1113, Philippines Date: ________________

COLLEGE OF MEDICINE
APPLICATION FOR ADMISSION
FOR THE ACADEMIC YEAR 20__ -20__ ATTATCHED 2X2
COLORED PHOTO
WHITE
BACKGROUND

(Please Print or Type)

1. Name: ______________________________________________________________________________________________
(Family Name) (First Name) (Middle Name)

HEREBY applies for admission to the College of Medicine UERMMMCI and submits hereunder facts as a true and correct
statement of his/her history and education.

2. Age: ____ Gender: ____ Citizenship: _____________________ Religion: __________________ Civil Status ___________

3. If Married, name of Spouse: ____________________________________________________________________________

Address of Spouse: ________________________________________Occupation: ___________________________________

4. Date of Birth: ___________________________________ Place of Birth: _________________________________________

(Day) (Month) (Year)

5. Permanent Home Address: _____________________________________________________________________________

Cellular Phone No.: _________________________________ Residence Landline No.: (____) _____________________

E-mail Address/es frequently used: ____________________________________ Fax No.: (____) ___________________

6. Present Address: ________________________________________________ Tel No.: (____) ___________________

7. Mailing Address: _________________________________________________ Tel No.: (____) ___________________

8. Parents: (Mark with a cross(+) if deceased)

(TO BE FILLED UP BY THE Father: _____________________________ Occupation: ___________________________

REGISTRAR’S STAFF)
Mailing Address: ___________________________________________________________

BS/BA : _______________ Cellular Phone No.: ___________________ Residence Landline No.: _________________

G.W.A. : _______________ E-mail Address: ____________________________________________________________

F’S : __________________
Mother: _____________________________ Occupation: ___________________________
NMAT %ile : ____________
Mailing Address: ___________________________________________________________

Cellular Phone No.: ___________________ Residence Landline No.: _________________

E-mail Address: ____________________________________________________________

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8a. Are you a child of UERM Alumni? Please tick appropriate box.

[ ] No

[ ] Yes, my father graduated from the College of ___________________________________ Class __________________

[ ] Yes, my mother graduated from the College of ___________________________________ Class __________________

9. Guardian other than parents:

Occupation : ______________________________________________________ Contact No.: (____) ____________________

Home Address : ________________________________________________________________________________________

10. If your family does not live in Manila area, where do you expect to live if admitted to this medical school ?

( State if with relatives, in boarding houses, etc.) ____________________________________________________________

11. Region of Origin : ____________________________________________________________________________________

12. Education:
School Attended Date of Attendance Title/Degree Units Earned

a) Primary: ___________________ ______________________ _________________ _______________

(Grade I – IV)

b) Intermediate: _____________________ ________________________ ___________________ ________________

(Grade V-VI)

c) Secondary : _____________________ ________________________ ___________________ ________________

(High School)

d) College :
st
1 Year: _____________________ __________ To ___________ ___________________ ________________
nd
2 Year: _____________________ __________ To ___________ ___________________ ________________
rd
3 Year: _____________________ __________ To ___________ ___________________ ________________
th
4 Year: _____________________ __________ To ___________ ___________________ ________________
th
5 Year: _____________________ __________ To ___________ ___________________ ________________

Degree _________________________________ Date graduated or expected date of completion: _____________________

Other collegiate courses taken (degree if any), where and when taken:

__________________________________________________________________________________________________________

__________________________________________________________________________________________________________

13. How do you plan to finance your medical education?

( In terms of percentage [%])

Your Resources: ___________________ Your Family: ______________________ Other Relatives: _________________

PVA- Period of Benefits: ____________________ Other sources, scholarship, Aid, Funds etc.: ______________________

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14. Combined annual income of parents: ___________________________________________________________________

15. Have you applied for admission to any medical school/s? ___________________________________________________

If so, at what medical school/s and what is the status of your application? _________________________________________

____________________________________________________________________________________________________

16. Have you studied in any College of Medicine? [ ] Yes. [ ] No. If yes, where and when ___________________________

Give reasons for withdrawing: ____________________________________________________________________________

17. Employment and /or any other pursuit, past and present: ____________________________________________________

18. Are you graduating with honors? Please tick appropriate box.

[ ] No

[ ] Yes, I graduated / expected to graduate:

[ ] Summa Cum Laude [ ] Magna Cum Laude [ ] Cum Laude [ ] Honorable Mention

I have received the following awards: Please tick appropriate box. Please use extra sheet if necessary.

[ ] Dean’s List/President’s List

School Year Semester/Trimester/Summer

___________________________________ ____________________________________

___________________________________ ____________________________________

___________________________________ ____________________________________

[ ] Non – Academic awards: Please Specify _____________________________________________________________

[ ] Other awards ___________________________________________________________________________________

State any additional information concerning yourself which you believe might be useful to the COMMITTEE ON

ADMISSIONS in evaluating your application. ( Membership in societies, Athletics, College Publications, Student

Government, School Organization, any extra – curricular activities in school etc. ) Please use extra sheet if necessary.

_________________________________________________________________________________________________

_________________________________________________________________________________________________

19. Have you done any research work/thesis during your pre-med years? If so, state the title of your research work.

_________________________________________________________________________________________________

__________________________________________________________________________________________________

20. Have you taken the NMAT before? Please tick appropriate box.

[ ] No. [ ] Yes, when? _____________________________

What was your NMAT score? ___________

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a) Have you enrolled in any Review Center for the NMAT?

[ ] No. [ ] Yes, please state Review Center/s: _________________________________________________________

Do you think the review course has been useful for the exam? [ ] Yes [ ] No

21. Give names and addresses of three persons (not relatives) who have known you and can be a character references, with
whom the Committee on Admission can correspond. At least one of the above should be someone who has known you as student
in college and who has handed you in class.

1. _____________________________________________________________________________________________

________________________________________________________________________________________________

2. _____________________________________________________________________________________________

________________________________________________________________________________________________

3. _____________________________________________________________________________________________

___________________________________________________________________________________________________________

22. I certify that

a) I have not withheld from this application any information that might be an obstacle to my admission.
b) I have not been debarred from any medical school.

23. I fully understand that among other requirements to be satisfied for admission to the College of Medicine,
UERMMMCI.
I must be a holder of a bachelor’s degree in Arts or Science.
.
I understand further that the above requirements must have been earned not later than the end of the second
semester Immediately preceding the school year for which I am seeking admission.

I HEREBY PLEDGE that if admitted to the College of Medicine, UERMMMCI, I shall comply with the rules of
the college now in effect or which hereinafter may be formulated.

I further pledge that I shall not join any campus organization not recognized by the school including
fraternities and Sororities.

My Enrollment will be automatically cancelled if I have enrolled under FALSE PRETENCES, such as the use
of irregular credentials, being debarred from re-admission for reason of poor scholastic standing or for disciplinary
action and my graduation in due time depends, not only in completion of academic requirements, but also on required
units in : Rizal course, National Service Training Program, Physical Education (Male and female) Land Reform and
Taxation, and The New Philippine Constitution and others as required by law and/or directives of the Commission on
Higher Education ( CHED )

NOTE:
ALL DOCUMENTS FILED IN SUPPORT OF THE APPLICATION BECOMES THE PROPERTY OF THE
UNIVERSITY OF THE EAST RAMON MAGSAYSAY MEMORIAL MEDICAL CENTER, INC. AND WILL
NOT BE RETURNED ANYMORE TO THE APPLICANT.

____________________________________
Printed Name of Applicant

Date Accomplished: ____________________________ ____________________________________

Revised: 090109 Signature of Applicant
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