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University of San Agustin: General Luna ST., Iloilo City 5000, Philippines WWW - Usa.edu - PH

This document contains forms for students of the University of San Agustin College of Health and Allied Medical Professions-Nursing Program. The first section collects personal information of the student and their parent/guardian. The second section is used to record the subjects enrolled in and midterm and final grades for the first semester of the 2020-2021 academic year. The final sections provide spaces for students to detail any issues or concerns regarding their online classes, activities, lecturers, or other problems encountered.

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Meia Jaycel
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180 views2 pages

University of San Agustin: General Luna ST., Iloilo City 5000, Philippines WWW - Usa.edu - PH

This document contains forms for students of the University of San Agustin College of Health and Allied Medical Professions-Nursing Program. The first section collects personal information of the student and their parent/guardian. The second section is used to record the subjects enrolled in and midterm and final grades for the first semester of the 2020-2021 academic year. The final sections provide spaces for students to detail any issues or concerns regarding their online classes, activities, lecturers, or other problems encountered.

Uploaded by

Meia Jaycel
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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University of San Agustin

General Luna St., Iloilo City 5000, Philippines


www.usa.edu.ph
COLLEGE OF HEALTH AND ALLIED MEDICAL PROFESSIONS-NURSING PROGRAM

Insert picture

PERSONAL INFORMATION
Complete Name (Last name, First name, Middle Name):
Age:
Date of birth (mm/dd/yyyy):
Phone Number:
USA email address:
Permanent address:

PARENT/GUARDIAN INFORMATION
Complete Name (Last name, First name, Middle Name):
Relation:
Phone Number:
Permanent Address:

SUBJECTS ENROLLED FOR THE FIRST CYCLE, 1ST SEM. AY 2020-2021


SUBJECTS
MIDTERM FINAL
(COURSE CODE AND COMMENT COMMENT
GRADE GRADE
COURSE TITLE)

DECLARATION. I agree that the above information is true, correct, and free from any errors or spelling. I
understand that my information will be used for school purposes pertaining to identifying the mode of
learning and the status of enrollment.

DATA PRIVACY STATEMENT. I acknowledge and agree that my information may be processed by the
University of San Agustin CHAMP-Nursing following the legal and regulatory standards of data protection
and privacy. By submitting the file, I am giving consent to the collection of data information for the purposes
of this learning in accordance with R.A. 10173 (Data Privacy Act of 2012).

_______________________________
Signature over Printed Name
Date:

Name (Last Name, First Name, Middle Name):


A Legacy of Excellent Education in Virtus et Scientia
Email: vpaaoffice@usa.edu.ph | Tel. No.: (033) 337-4841 | Fax No.: (033) 337-7716
University of San Agustin
General Luna St., Iloilo City 5000, Philippines
www.usa.edu.ph
COLLEGE OF HEALTH AND ALLIED MEDICAL PROFESSIONS-NURSING PROGRAM

Year and Section:

Instruction: Please type your issues/concerns in a narrative form per section specifying the date and time of
occurrence of the problem, the nature of the problem and the class subject/s or teacher/s involved for
proper referral and immediate action. Just type NONE if otherwise.

CONCERNS OR ISSUES ON ONLINE CLASSES

CONCERNS OR ISSUES ON ONLINE ACTIVITIES

CONCERNS OR THE LECTURER/S BOTH GENERAL AND PROFESSIONAL SUBJECT

OTHER ISSUES OR CONCERNS ENCOUNTERED

_______________________________
Signature over Printed Name
Date:

A Legacy of Excellent Education in Virtus et Scientia


Email: vpaaoffice@usa.edu.ph | Tel. No.: (033) 337-4841 | Fax No.: (033) 337-7716

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