(Updated: March 2015)

PRELIMINARY REGISTRATION FORM (PRF)

MSU-Iligan Institute of Technology
Andres Bonifacio Avenue, Tibanga, Iligan City, 9200, Philippines

I.D. No. Family Name First Name Middle Name Suffix Sex Age Civil Status
Single
Male Married
Female Separated
Widow/er
Permanent Residence and Contact Information Place of Birth
_______________
Street/Purok Barangay Town/City Province Region
Date of Birth
_____________
Landline No. Mobile No. Email Address Religious Affiliation
Aglipayan
Baptist
Buddhist
In Case of Emergency Iglesia ni Kristo
Contact Person Relationship Phone No. Address Islam
Protestant
Roman Catholic
Seventh Day Adventist
Others (pls specify):
Academic Year Semester/Term Date of Registration GPA Scholarship
st nd
1 2 Summer
Year Level: 1st 2nd 3rd 4th 5th Course/Major: Ethnic Affiliation
B’laan
Hrs/Wk Badjao
Course
Section Course Title Time Days Units Room Bagobo
No. Lec Lab Bisaya
Chavacano
Chinese
Higaunon
Ilocano
Ilonggo
Maguindanao
Manobo
Maranao
Subanon
Surigaonon
T’boli
Tagalog
Tausug
Others (pls specify):

Monthly Gross
Family Income(Php)
10,000 and below
10,001 to 20,000
20,001 to 30,000
30,001 to 40,000
40,001 to 50,000
50,001 to 70,000
70,001 to 100,000
100,001 and above
Request for Approval: Approved:

____________________________ ____________________________
Student’s Signature Over Printed Name Adviser’s Signature Over Printed Name