DIVINE WORD COLLEGE OF SAN JOSE

Gen. Lukban St., San Jose, Occidental Mindoro

REGISTRATION FORM (NEW STUDENT)

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ID NO.

NAME:

Last Name First Name MI

Address: ______Major: ______

Course: ______Year: 1st 2nd 3rd 4th 5th

1st Sem. 2nd Sem Summer School Year 20______- 20______

Date of Registration: ______Credential Submitted: Form 138 HD TR Others ______

OFFERING NO. / SUBJECT / UNITS / TIME / DAYS / ROOM

Total Units: ______

I certify that I have passed prerequisite of the subjects listed below.

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______Student’s Signature

Dean/Registrar or Representative

STUDENT’S PERSONAL DATA

Name: ______Sex: ______Age: ______

(Family Name) (First Name) (Middle Name)

Date of Birth: ______Place of Birth: ______

Religious Affiliation: ______Occupation: ______

Student’s SAN JOSE Address: ______

(House No. & Street) (Barrio/Town) (Province)

Name of Guardian in San Jose: ______

Home Address: ______

(House No. & Street) (Barrio/Town) Province

Name of Parents: ______

Father’s Name Mother’s Name

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Profession Profession

School Attended / Year of Attendance / Year Graduated / REMARKS: Course, Honor
From / To / No. of Units Completed, etc.
Primary
Intermediate
HS 1st
2nd
3rd
4th
College

I hereby certify to the correctness of the above data. I also hereby bind myself to abide by the rules and regulations of the school.

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Student’s Signature.

SCHOOL FEES

SCHEDULE OF FEES / SCHEDULE OF PAYMENTS / PAYMENTS
Date / OR No. / Particulars / Charges / Payments / Balance
Tuition / DP / P / ______
Matriculation
Miscellaneous Fees / Premid / ______
Insurance
Laboratory (Science) / Midterm / ______
Computer Lab
Testing Fee / Prefinals / ______
Security Fee
Identification Card / Finals / ______
Course Dev't Fee
Fac. Dev't Fee / Total / P / ______
Sch. Publication
School Organ
HRM/Speech Lab
Internet Fee
Others / Assessed by: ______
TOTAL

I hereby promised to pay my account before taking the examinations as scheduled. I bind myself to abide by the rules, regulations and policies of the Divine Word College of San Jose.

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Finance Officer or Representative Student’s Signature