Registration Form 2nd Sem

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HEADQUARTERS

DEPARTMENT OF MILITARY SCIENCE AND TACTICS


LEYTE COLLEGES ROTC UNIT
TH
804 (LYN) CDC, 8RCDG, RESCOM PA
Paterno St. Tacloban City

ROTC REGISTRATION FORM

Student No: ______ MS: _______ DATE: ____________________

Name: ______________________________________________________________________________

(Last Name) (First Name) (Middle Name)

Temporary Address:

No/St/Vill/Brgy: ________________________________________________________________

Municipality: ___________________________________________________________________

Province: ______________________________________________________________________

Telephone/Cell Number: _________________________________________________________

Course: ____________ School: _________________ Religion: __________________

Date of Birth: ______________ Place of Birth: ________________________________________

Height: _______ Weight: ___________ Complexion: __________ Blood Type________

Permanent Address:

No/St/Vill/Brgy: _______________________________________________________________________

Municipality: ___________________________________________________________________

Province: ______________________________________________________________________

Telephone/Cell Number: _________________________________________________________

Father: ___________________________________________ Occupation: ______________________

Mother: __________________________________________ Occupation: ______________________


Person to be Notify in Case of Emergency:

Name: _______________________________________ Relationship: _____________________

Address: ______________________________________________ Cell No: ___________________

Military Science Completed:

MS SEMESTER SCHOOL YEAR GRADE REEMARKS


____________ ___________ ____________ ___________ ___________

____________ ___________ ____________ ___________ ___________

____________ ___________ ____________ ___________ ___________

Are you willing to take Advance Course? ( ) YES ( ) NO

__________________________________

(Signature of Student)
BASIC INFORMATION ABOUT YOURSELF

NOTE: PLEASE WRITE CLEARLY AND BE SPECIFIC AND WRITE IN PRINTED LETTERS

NAME: ________________________________________________________________

NICKNAME: ______________________________________________________________

SEX: _______________ HEIGHT: ____________ WEIGHT: ___________

AGE: _____________ HOBBIEES: _______________________________

TALENT/SKILL: _____________________________________________

DATE OF BIRTH: _____________________________________________

ADDRESS: __________________________________________________

NAME OF PARENT/GUARDIAN:

FATHER: _______________________________________ OCCUPATION: ____________________

MOTHER: _____________________________________ OCCUPATION: ____________________

GUARDIAN: ___________________________________ OCCUPATION: ____________________

CONTATCT NUMBER: _____________________________

PLEASE HONESTLY ANSWER THE FOLLOWING QUESTIONS:

ARE YOU DEPENDENT FROM YOUR FAMILY? ________________________________________________

ARE YOU INDEPENDENT FROM YOUR FAMILY? ______________________________________________

ARE YOU PROODUCT OF A BROKEN FAMILY? ________________________________________________

HAVE YOU BEEN OR CURRENTLY INVOLVE FROM ANY ORGANIZATION? __________________________

_____________________________________________________________________________________

WHY DO YOU INTEND TO JOIN ROTC CADET OFFICERSHIP? ____________________________________

_____________________________________________________________________________________
_____________________________________________________________________________________

________________________________

SIGNATURE

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