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Degree

 (for  Undergraduate  and  Graduate  Studies):  


____________________________________________________________________________________________    

Certificate/  Diploma:  
  ____________________________________________________________________________________________          
Registration  Form  
 
Track/Strand  (For  Senior  High):  
Name:____________________________________________________________________________________  
Last  Name     First  Name     Middle  Initial  
! Academic  -­‐  ABM   ! Academic  -­‐  STEM  
 
! Academic  -­‐  HUMSS   ! Academic  –  General  
Name  to  be  put  on  the  nametag:  _______________________________________Age:  _________  
! Arts  and  Design   ! Sports  
Local   Church   Membership:   ________________________________________________________  
! TVL  -­‐  Home  Economics   ! TVL  -­‐  Agri-­‐Fishery  
Conference:  ______________________________________________________________________________  
! TVL  -­‐  Industrial  Arts   ! TVL  -­‐  ICT  
Jurisdiction:  _____________________________________________________________________________  
Name  of  school  where  you  completed  your  studies:  
CYF  Membership  (please  check):      
____________________________________________________________________________________________  
[    ]  Regular        [      ]  Associate        [      ]  Affiliate        [    ]  Honorary                    [      ]  Non-­‐member
Occupation  (if  working):  _______________________________________________________________            
School  (if  still  studying):  _______________________________________________________________    
Current  Position:  __________________________________________  Term:  _____________________  
Do  you  have  any  health  problems,  allergies,  dietary  restrictions  or  
For  Non-­‐UCCP/CYF  Member,  Name  of  Denomination/Faith:  
requirements?  [      ]      Yes        [      ]      No    
____________________________________________________________________________________________  
If  yes,  please  describe:  
Address:__________________________________________________________________________________  
____________________________________________________________________________________________
____________________________________________________________________________________________  
Contact  number:______________________________________  E-­‐mail:  _________________________  
Person  to  contact  in  case  of  emergency:    
Birthplace:  _______________________________________________________________________________     Name:  ____________________________________________________________________________________  
Relationship:  ____________________________________________________________________________    
Birth  Date:  Day  _____________  Month  ______________________  Year________________________    
Home  Address:  __________________________________________________________________________  
Gender:          [        ]Male                [          ]  Female                  Civil  Status:  [          ]Single                [          ]Married     Contact  number:  ________________________________________________________________________    
Primary  Language:  _____________________________________________________________________                 Please  indicate  the  gifts  and  talents  that  you  have  to  share:  
Other  Language/s  Spoken:  ____________________________________________________________     ____________________________________________________________________________________________
____________________________________________________________________________________________                                  
English  Language  skills:  [    ]  excellent    [    ]  very  good        [    ]  functional      [    ]very  little    
What  are  your  expectations?  
Highest  Educational  Attainment:   ____________________________________________________________________________________________
! Graduate  Studies  (MS,  MA,   ! Undergraduate  Studies  (BS,   ____________________________________________________________________________________________
MBA,  MD,  Law,  PhD,  etc)   BA,  AB)   ____________________________________________________________________________________________  
! Certificate/Vocational   ! Senior  High  School    
! Junior  High  School     ! Elementary   Is  it  your  first  time  to  attend  the  NYC?      [      ]      Yes        [      ]      No