Please DO NOT fold this form and make sure that your penmanship is READABLE for data entry

purposes.

Form 2/RRF
DEPARTMENT OF MILITARY SCIENCE AND TACTICS
SILLIMAN UNIVERSITY RESERVE OFFICER TRAINING CORPS UNIT
Dumaguete City

ROTC REGISTRATION FORM

Student ID Number: _________________ MS: ___2____ DATE: ___________

Name: ______________________________________________________________________________
(Last Name) (First Name) (Middle Name)
Telephone/Cel Nr : _________________________________________________
Dumaguete City Address (No/St/Vill/Brgy): _________________________________________________
City: : _________________________________________________
Course: ___________________ School: Silliman University Religion: ___________________
Date of Birth: __________________ Place of Birth: _______________________________ Age: ____
Height (ft): ____ Weight (kg): _____ Complexion: ____________ Blood Type: ____ Gender: ___
Home Address (No/St/Vill/Brgy) : ______________________________________________________
Province: : ______________________________________________________
Telephone/Cell Nr of Parents : ______________________________________________________
Father: _______________________________________ Occupation: _____________________________
Mother: ______________________________________ Occupation: _____________________________
Person to be notified in case of emergency:
Name: ____________________________________________ Relationship: _______________________
Address: ______________________________________________ Tel. No.: _______________________
Military Science (MS) Completed:
MS SEMESTER SCHOOL YEAR GRADE REMARKS
_______ ____________ _______________ _________ _____________
_______ ____________ _______________ _________ _____________
_______ ____________ _______________ _________ _____________
Are you willing to take the Advance ROTC Course? (__) Yes (__) No
(YES, if you want to be a cadet officer, NO if not)

RAFAEL CRESCENCIO C TAN JR _____________________________________

LT COL JAGS (RES) Parent/Guardian (Please Underline)
Asst. Commandant

SUROTCU

TO WHOM IT MAY CONCERN:

THIS IS TO CERTIFY that ___________________________________________, from the College of

___________________________________ is duly registered in MS ____2____ of the ROTC Program for the
__2nd_ Semester School Year _2019_ – _2020_

LUCELO Q BETINOL
MAJ (INF) PA
Commandant