Application No.

_______________________

INDIVIDUAL INVENTORY FORM

PRINT all information neatly and legibly and ATTACH a 2x2 photo on the space provided for. This form
will only be filled out ONCE. Please inform this office of any change/s in the given information as soon as ATTACH
possible.
Requirements: 2 X 2 PHOTO

1. Preliminary interview upon application. HERE

2. Copy of Report Card or Transcript of Records (should be certified by Authorized Person)
3. Copy of Certificate of Good Moral Character
4. Copy of PSA Birth Certificate
5. Two (2) ID pictures (2 x 2)
6. Guardian’s / Parent’s Barangay Clearance or Applicant’s Barangay Clearance (if already 18 years old) with
PROGRAM PASSED:
number of years of residency
Transferee
CLASSIFICATION: (Please check.)
Freshman Transferee STUDENT ID NO.
PREFERRED PROGRAMS: (Please check.)
FIRST PRIORITY PROGRAM SECOND PRIORITY PROGRAM
___ Bachelor of Science in Computer Science ___ Bachelor of Science in Computer Science
___ Bachelor of Science in Information Technology ___ Bachelor of Science in Information Technology
___ Bachelor of Science in Accountancy ___ Bachelor of Science in Accountancy
___ Bachelor of Science in Accounting Information Systems ___ Bachelor of Science in Accounting Information Systems
___ Bachelor of Elementary Education ___ Bachelor of Elementary Education
___ Bachelor of Secondary Education ___ Bachelor of Secondary Education
___ English Language Education ___ English Language Education
___ Mathematics Education ___ Mathematics Education
___ Science Education ___ Science Education

PERSONAL INFORMATION

____ Recipient of Student Financial Assistance Program (StuFaP) ____ Member of Indigenous People
____ Person from Disadvantaged Group ____ Person with Disability (PWD)
____ Person from Depressed or Conflicted Areas ____ Recipient of 4Ps

FULL NAME ______________________________________________________________________________________

LAST NAME FIRST NAME MIDDLE NAME NAME EXTENSION NICKNAME

DATE OF BIRTH: ____/____/______ (mm/dd/yyyy) PLACE OF BIRTH: __________________________________ AGE: _________

SEX: MALE FEMALE RELIGION: ______________________________________________
CIVIL STATUS: SINGLE MARRIED WIDOWED SEPARATED
IF MARRIED, NAME OF SPOUSE: ____________________________________________________________
SPOUSE’S OCCUPATION: __________________________________________________________________
SPOUSE’S EMPLOYER, ADDRESS AND CONTACT NUMBER:
_________________________________________________________________________________________
_________________________________________________________________________________________
NAME/S OF CHILDREN (if any) AGE SEX
__________________________________ ____________ __________
__________________________________ ____________ __________
__________________________________ ____________ __________
PRESENT ADDRESS __________________________________________________________________________ POSTAL CODE_______________
PERMANENT ADDRESS _______________________________________________________________________ POSTAL CODE_______________
EMAIL ADDRESS: __________________________________________________________ CONTACT NUMBER: ____________________________

EDUCATIONAL BACKGROUND
TECHNICAL/
ELEMENTARY JUNIOR HIGH SENIOR HIGH TERTIARY VOCATIONAL
COURSE
SCHOOL

ADDRESS

DATE
GRADUATED
HONORS/AWARDS
RECEIVED
SHS SECTION PROGRAM COURSE TAKEN
SHS ACADEMIC
STRAND SHS GWA GWA

Rev. 3 Year 2018

FULL NAME ______________________________________________________________________________________
LAST NAME FIRST NAME MIDDLE NAME NICKNAME

HOBBIES AND INTERESTS

ORGANIZATIONAL INVOLVEMENT

YEAR OF JOINING
NAME OF ORGANIZATION POSITION IN ORGANIZATION NATURE OF ORGANIZATION THE ORGANIZATION

PARENTS’ DATA

FATHER MOTHER
COMPLETE NAME
CITIZENSHIP
DATE OF BIRTH
CONTACT NUMBER
PRESENT ADDRESS
OCCUPATION
NAME OF COMPANY
COMPANY ADDRESS
COMPANY'S CONTACT NUMBER
HIGHEST EDUCATIONAL ATTAINMENT
MONTHLY INCOME

NAME OF GUARDIAN ______________________________________________ RELATIONSHIP _____________________________

PRESENT ADDRESS ______________________________________________ DATE OF BIRTH _____________________________
OCCUPATION __________________________________________________ CONTACT NUMBER ___________________________

BROTHER/S AND SISTER/S (Please list from eldest to youngest.)

NAME AGE CIVIL STATUS CONTACT NUMBER

REASON/S FOR ENROLLING AT CITY COLLEGE OF CALAMBA (CCC)

DESCRIBE YOURSELF (PHYSICAL and INNER CHARACTERISTICS)

Envision yourself ten (10) years from now.

I, certify that the information contained herein is true and correct. I understand that any wrong information, deliberately
entered or not, may jeopardize my admission to the City College of Calamba. Furthermore, I authorized the Office of the Registrar of
the City College of Calamba, as well as the other offices within the said Institution to obtain and release information (written or verbal)
regarding my Personal Data which are stated below:

Full Name (Including Middle Name), Address, Contact Number, Email Address, Date of Birth, Place of Birth, Grade and GWA, Course and
Major taken, Previous School Attended, Date of Graduation, Special Order No., NSTP Serial Number, Official Picture, and other Enrollment Data.

The display and release of the abovementioned data for employment/student verification, request of Batch Directory, posting
for academic and non-academic achievements, and other legal purposes are permissible.

________________________________________ _______________________
APPLICANT’S SIGNATURE DATE

Rev. 3 Year 2018