BCC

STUDENT APPLICATION FORM

Available Enrollment

ENROLLMENT INFORMATION

School Year

Semester

Pre-registration Type * Application type is required

Grade Level to enroll * Grade level is required.

LRN LRN is required.

STUDENT PERSONAL INFORMATION

First Name * First Name is required

Middle Name

I don't have a middle name

Last Name * Last Name is required

SUFFIX Suffix is required

Date of birth * Date of birth is required

Place of birth * Place of birth is required

Name in Native Language Character

Mother Tongue

Gender * Gender is required

Ethnic Group

Religion * Religion is required

Nationality * Nationality is required

Street * Street is required

Barangay * Barangay is required

City/Municipality * City is required

Province * Province is required

Mobile Number * Mobile number is required

Email Address (Optional) Email address is required

PARENTS | GUARDIAN INFORMATION

Scroll right for more information

	First Name	Middle Name	Last Name	Suffix	Contact #	Occupation/Relation	Educational Attainment	Home Address
Father *
Mother*
Mother Maiden Name *
Guardian *

*In case of emergency ( Recipient for News, Announcement and School Information)

Father

Mother

Guardian

SOCIO ECONOMIC PROFILE

	Educational Attainment	Occupation	Monthly Income	Other Source of Income	Ethnicity
Father
Mother
Guardian

EDUCATIONAL INFORMATION

Name of School Last Attended

Grade Level in that School

School’s Contact No.

Complete Mailing Address of School last Attended

Educational Background
	School Name	S.Y. Graduated	School Type
Pre-school
Grade School
Junior High School
Senior High School
College

MEDICAL INFORMATION

Vaccinated:

Yes

In case of emergency is required

Allergy/ies: (food, medication, insects, plants, animals etc.)

Are there any factor that make it advisable for your child to follow a limited program of physical acitivity? (i.e asthma, recent surgery, heart condition and etc.) if yes, specify the ways in which you wish his/her program limited. (W/ Physician’s Medical Certificate)

Allergies to Medication

Medical History

Any additional information of which MDA should be aware concerning student’s health

REQUIREMENTS

Requirement Description
Note: Old/Continuing Students don’t have to upload requirements ( unless specified and requested by the Registrar’s Office). You can skip this step by clicking next. For New/Transferee students please submit a hard copy of the requirements to the registrars office.

TERMS AND AGREEMENT

I confirm that I have read, understand and agree to the above terms and agreement for enrollment of BINALBAGAN CATHOLIC COLLEGE, INC.