LCCM Application Form

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APPLICATION FORM

LA CONSOLACION COLLEGE MANILA


8 Mendiola Street, Malacañang Complex, San Miguel, Manila,
Philippines 1005
Trunklines: 8736-0235/ 8310-0513 loc. 150
Email Address: [email protected]
Website: www.lccm.edu.ph
Paste 2in. x 2in.
YEAR LEVEL: Freshman Transferee Second Course Taker
picture here
GENDER: Male CIVIL STATUS: Single

COLLEGE PROGRAM APPLIED FOR: BSHM - Cruise Ship Management

PERSONAL INFORMATION
NAME: Nanglegan Jethro Cumahling
Last Name First Name Middle Name
DATE OF BIRTH: August 12 2002 PLACE OF BIRTH: Bitu, Hingyon, Ifugao
Month Day Year
NATIONALITY: Filipino RELIGION: Catholic

HOME ADDRESS: Culob, Bitu, Hingyon, Ifugao ZIP Code: 3607

EMAIL ADDRESS: [email protected] LANDLINE NO. MOBILE NO. 09772941298

SCHOOL LAST ATTENDED: Lyceum of the Philippines University-Manila YEAR GRADUATED: *2020

SCHOOL ADDRESS: Muralla st, Intramuros , Manila STRAND: ABM

FAMILY BACKGROUND

FATHER’S NAME: Nanglegan Eduard Dulnuan


Last Name First Name Middle Name
OCCUPATION: Police CONTACT NUMBER: 09067151876

MOTHER’S NAME: Nanglegan Marina Cumahling


Last Name First Name Middle Name

OCCUPATION: N/A CONTACT NUMBER:

GUARDIAN’S NAME: Nanglegan Beverly Joy Cumahling


Last Name First Name Middle Name
OCCUPATION: Police CONTACT NUMBER: 09060067921

TERMS AND CONDITIONS:

I am aware that the La Consolacion College Manila will create and maintain computerized and hard copy records of my
personal data in the course of my study and after I leave the College. I hereby give my consent that my personal data in
the custody of the College may be used for internal reports and for related student administration to external parties,
within the bounds of the Data Privacy Act of 2012.

NANGLEGAN,JETHRO C. 07/12/2020

Signature over printed name Date signed (MM/DD/YYYY)


NOTE: A signed copy of this Application Form should be submitted together with other pertinent requirements to the Admissions Office when face-to-
face classes resume.

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