J.H.

CERILLES STATE COLLEGE

Enrolment Form
First Semester, S.Y. 2019-2020

Student Name :
(Last Name) (First Name) (Middle Name) (Name Extension)
Course : Year Level : Civil Stat :
Major : Tribe :
Sex at Birth : Nationality : Religion :
Date of Birth : Place of Birth :
Mobile Number : Email : Tel. No. :
Present Address :
Home Address :

Schools Attended Name of School Address of School

Elementary
Secondary
Last Term of
School last attended (other than JHCSC) : :
Attendance
Financial Support [ ] Parents [ ] Self-Supporting [ ] Gov't/Private Agency, state the name :
Parent's/Guardian's Name : Relationship :
Parent's/Guardian's Monthly Income : Occupation :
Parent's/Guardian's Mobile/Tel. Number(s) : Email Address :

EDP Code Course # Time Days Unit(s) Enrolment Steps

1 Admission Section

1.1 Admission Officer

1.2 Guidance Counselor

2 Advising Section

3 EDP Center

4 College Clinic

5 DSA/SSC Treasurer

6 Registrar's Section
Total Units >>>>
To be filled up by the Class Adviser
Admission Status : [ ] Regular [ ] Probational
Enrolment Status : [ ] Freshman [ ] Old Continuing [ ] Transferee [ ] Shifter [ ] Returnee [ ] Second Courser
Advised by : Certified Correct : Encoded by :

_____________________ _____________________ _____________________

Class Adviser/Liaison Officer Dean/Program Coordinator EDP Personnel

NOTE
The College considers you officially enrolled only after you have:
a. submitted the DULY ACCOMPLISHED ENROLMENT FORM and OTHER ENROLMENT DOCUMENTS to the Registrar's Office; and
b. been issued a CERTIFICATE OF REGISTRATION for the corresponding subjects reflected in the ENROLMENT FORM.
ACKNOWLEDGEMENT
In consideration of my admission to the J.H. Cerilles State College, I hereby promise to abide and comply with the rules and regulations laid down by
competent authorities in the College.

________________________________
Student's Signature over Printed Name

“ Quality Education for Service ”