Application Form (Basahin Muna Ang General Instructions Sa Baba Bago Sagutan

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DON MARIANO MARCOS MEMORIAL STATE UNIVERSITY

Bacnotan, La Union, Philippines


Latest
Application Date: ____________ 2” x 2”
Colored ID picture
w/ NAME TAG
NOTE: Read the GENERAL INSTRUCTIONS first before filling out the College w/ WHITE Background
Application Form (Basahin muna ang general instructions sa baba bago sagutan
ang College Aplication Form)
Batch No. (For DMMMSU use only):
Control No. (For DMMMSU use only):

COLLEGE ADMISSION APPLICATION FORM

Name (Pls. Print):


Last Name First Name Middle Name

LRN: ____________________________ Birthdate:


Home Address:
(Barangay) (Municipality/City) (Province) (Zipcode)
E-mail Address: CP No. Sex:
Please Check:
Incoming Freshman
School where graduated:
Address:
Track: Strand:
School Year Graduated: ___________________
Type of School: Private Public
Transferee
School last attended______________________________________________________
Address:______________________________________ Sem/SY _________________
Type of School: Private Public
Campus Preference: NLUC MLUC SLUC OUS

Course Preference: First Priority:_________________ Second Priority: ___________________

IF ACCEPTED:
What will be your living arrangement? (Please Check)
Boarding House Live with relatives Live with family and will just commute going to
school
Mode of learning preference (check one only)
Classroom (C) Modular (M) Online (O) (if online, please check if the following are available):
Desktop Laptop Cellphone Internet Connection
Blended
C&M C&O M&O

Admission Requirements: I hereby declare that all information in this


1. Two (2) pieces 2”x2” identical latest I.D. picture with name tag in white background application is true and correct. I understand that any
FOR APPLICATION:
2. Photocopy of Form 138/Report Card (Back &Front Page) with 2nd Grading Grade
false information may be a ground for disqualification
FOR ENROLMENT ON JULY 2021 for Admission in the University.
SENIOR HIGH SCHOOL-FORM 138/Report Card (Grade 12) with Grade Point Average (GPA) Indicated
TRANSFEREE: Transcript of Records or Certified True Copy grades.
_________________________
Signature of Applicant
Processed by: _____________________________________
SAS / Admission / Date

GENERAL INSTRUCTIONS:
1. Fill out ALL information needed in the College Application Form (Sagutan ang lahat ng hinihinging impormasyon sa College Application Form)
2. For the COURSE PREFERENCE. Please refer to the list of curricular offerings of DMMMSU at the back page. (Para sa COURSE
PREFERENCE, tignan ang listahan ng mga kurso na pwedeng kunin sa likod na pahina).
3. Attach ALL documents required. INCOMPLETE REQUIREMENTS WILL NOT BE PROCESSED (isama LAHAT ng kailangang dokumento sa
application form. Pag hindi kumpleto ang requirements ay hindi ito maproproseso).
4. Put all the required documents including the College Application Form in a long window envelope. Seal and drop it in the DMMMSU-drop box
located in your respective Municipality Hall. (Ilagay lahat ng kailangang dokumento kasama ang College Application Form sa loob ng long
window envelope, siguraduhing selyado ito bago ihulog sa DMMMSU-drop box na makikita sa inyong Munisipyo).
5. Log your name in the DMMMSU College Application Form Log Sheet (Huwag kalimutang isulat ang pangalan sa DMMMSU College Application
Log Sheet.

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