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ST Lukes App Form

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Cileate C.
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57 views1 page

ST Lukes App Form

Uploaded by

Cileate C.
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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ST.

LUKE'S COLLEGE OF MEDICINE


William H. Quasha Memorial
Photo
APPLICATION FOR ADMISSION 2" x 2"
SCHOOL YEAR

NAME
(Please Print ) LAST FIRST MIDDLE

Mailing Address_ Tel. No.

Permanent Address_ Tel. No.

Zip Code Cellphone No.

Date and Place of Birth Age: Gender Citizenship

Civil Status_ Religion E-mail Add

Father Occcupation Phone

Mother Occcupation Phone

Guardian Address_ Phone

Elementary School Year Graduated

High School Year Graduated

College Year Graduated

Pre-Med Course Year Graduated

School Last Attended School Year

Honors/Awards :

Give a candid evaluation of yourself, your strengths and weaknesses. (Use additional sheet if necessary)

What is the value of medical education to you? (Use additional sheet if necessary)

Who would fund your medical education?

How did you know of the St. Luke's College of Medicine - William H. Quasha Memorial?

Why St. Luke's College of Medicine? Please rank according to importance.


( 1 = most important; 6 = least important )

Curriculum Scholarship Opportunity Facilities

Reputation Career Opportunities Others


Have you applied in other medical school(s)?
[ ] No [ ] Yes
School Status of Application
Have you ever been enrolled in other medical school(s)?

[ ] No [ ] Yes
School Date/School Year

IF FOREIGN APPLICANT: ACR No. VISA STATUS

IMPORTANT: The application for admission does not mean automatic acceptance to the College of Medicine.

I certify to the veracity of the above information, any evidence of fraud in the credentials/documents submitted will automatically nullify my enrollment
in the College of Medicine.
I certify further that if accepted, I will abide by all the rules and regulations of the College and CHED.
OR No.
Signature of Applicant

Sta. Ignaciana St., New Manila, Quezon City Tel No. 7230301 Loc. 3808 Telefax No. 7277610
E-mail: registrar@stlukesmedcollege.edu.ph
Website: stlukesmedcollege.edu.ph

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