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    SY2017-2018 College of Med Application Form

    Uploaded by

    des.claver
    The document is an application form for admission to the College of Medicine at West Visayas State University for the 2017-2018 school year. The applicant provides their personal details and certifies that the information is true. The applicant's guardian also certifies that they are financially capable of supporting the applicant's medical education. The requirements for application include an application fee, ID photos, self-addressed envelopes, transcripts, NMAT results, certificates of good moral character, tax returns, birth certificate, ID, and documents must be submitted in a long white file folder by a specified deadline.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    SY2017-2018 College of Med Application Form

    Uploaded by

    des.claver
    36 views2 pages
    The document is an application form for admission to the College of Medicine at West Visayas State University for the 2017-2018 school year. The applicant provides their personal details and certifies that the information is true. The applicant's guardian also certifies that they are financially capable of supporting the applicant's medical education. The requirements for application include an application fee, ID photos, self-addressed envelopes, transcripts, NMAT results, certificates of good moral character, tax returns, birth certificate, ID, and documents must be submitted in a long white file folder by a specified deadline.

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    com app form

    Original Title

    SY2017-2018 college of med Application Form

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    The document is an application form for admission to the College of Medicine at West Visayas State University for the 2017-2018 school year. The applicant provides their personal details and certifies that the information is true. The applicant's guardian also certifies that they are financially capable of supporting the applicant's medical education. The requirements for application include an application fee, ID photos, self-addressed envelopes, transcripts, NMAT results, certificates of good moral character, tax returns, birth certificate, ID, and documents must be submitted in a long white file folder by a specified deadline.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    36 views2 pages

    SY2017-2018 College of Med Application Form

    Uploaded by

    des.claver
    The document is an application form for admission to the College of Medicine at West Visayas State University for the 2017-2018 school year. The applicant provides their personal details and certifies that the information is true. The applicant's guardian also certifies that they are financially capable of supporting the applicant's medical education. The requirements for application include an application fee, ID photos, self-addressed envelopes, transcripts, NMAT results, certificates of good moral character, tax returns, birth certificate, ID, and documents must be submitted in a long white file folder by a specified deadline.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    Application No.

    :________________

    APPLICATION FOR ADMISSION


    School Year 2017-2018

    ______________________________
    (Date)

    The Committee on Admissions


    College of Medicine
    West Visayas State University
    Iloilo City

    Sir/Ma’am:

    Please consider me an applicant for admission to the WVSU-College of Medicine for


    school year 2017-2018.

    I have read the regulations of the WVSU-College of Medicine and promise to abide by
    them.

    Here are my personal data and other pertinent documents for appraisal as well as
    payment for the application.

    Very truly yours,

    ______________________________
    (Signature over Printed Name)

    -x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-
    GUARDIAN’S / PARENT’S CERTIFICATION

    I have given permission to my child ________________________________________


    to apply at the WVSU-College of Medicine this coming academic year. I am financially capable to
    support his/her medical education.

    ______________________________
    Signature Over Printed Name of Parent/Guardian

    -x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-
    DEAN’S / REGISTRAR’S CERTIFICATION

    This is to certify that____________________________________________________


    an applicant for admission to the WVSU-College of Medicine, is a member of the
    (graduating/graduated)class of _________________ of the _______________________.
    (degree/school year) (college or university)

    _____________________________
    (Dean / Registrar)

    Paid Under OR No.:________________


    Date Paid:_______________________
    Amount: ________________________
    Posted By:_______________________
    STUDENT’S PERSONAL DATA

    Last Name:___________________ First Name:___________________ Middle Name:___________


    Email Address: __________________________ Contact #: _______________________________
    Date of Birth:___________________________ Age:_____________________________________
    Place of Birth:___________________________ Citizenship: Filipino
    Home Address:__________________________ Dual Citizen Specify: ___________
    Phone Number:_________________________ Sex:______ Civil Status: ____________________
    City Address:____________________________ Religion:_________________________________
    Phone Number:_________________________ Sibling Rank:______________________________
    Father:_________________________________ Occupation:______________________________
    Mother:________________________________ Occupation:______________________________
    Address of Parents:______________________ Phone Number of Parents:___________________
    Guardian:______________________________ Address & Phone Number:___________________
    Elementary School:______________________ Year Graduated:___________________________
    Secondary School:_______________________ Year Graduated:___________________________
    College or University Attended:______________________________________________________

    FOR DEGREE HOLDERS:


    Degree Earned:___________________________________________________________________
    Major:_________________________________ Minor:__________________________________
    Date of Graduation:______________________ S.O. No.:________________________________
    Academic Honors if any:_______________________________ GWA: ______________________

    FOR GRADUATING STUDENTS:


    Course Being Taken:_______________________________________________________________
    Major:_________________________________ Minor:__________________________________
    Tentative Date of Graduation:_______________________________________________________
    General Weighted Average (seven semester work):_____________________________________

    NMAT:
    How many times have you taken the NMAT?_________________________________________
    Specify dates: First:___________________ Percentile Rank:___________________
    Second:_________________ Percentile Rank:___________________
    Third:___________________ Percentile Rank:___________________

    Have you attended other medical schools?___________________________________________


    If yes, where?__________________________________________________________________
    Reasons for leaving:_____________________________________________________________

    CERTIFICATION

    I hereby certify on my honor that the aforementioned data are true and correct. I understand that
    any dishonesty or misinformation on my part shall be ground for the disqualification of my application to
    the WVSU-College of Medicine.

    _______________________________________
    (Signature of Applicant over Printed Name)
    REQUIREMENTS FOR APPLICATION
    1. Application Fee – PhP400.00 (non-refundable)
    2. 2 pcs. 2 x 2 recent ID picture
    3. 2 pcs. Self addressed envelope (long) with postage stamps
    4. Transcript of records (if machine copied must be authenticated by the Registrar) at least 80 GWA
    5. Machine copy of NMAT result (at least 60%)
    6. Certificate of Good Moral Character from the dean and guidance counselor/professor
    7. Income tax return (latest)
    8. NSO live birth certificate
    9. COMELEC ID / Certificate of Residency
    10. Lost application forms will not be replaced

    All documents must be placed in a long white file folder and must be submitted not later than ________________.

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