Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
Choice1
RAMON MAGSAYSAY MEMORIAL MEDICAL CENTER, INC.
Ref. No.201904627
#64 Aurora Boulevard, Barangay Doña Imelda,
Appl. No.2020005147
Quezon City, 1113 Philippines
OR No._____________
Website: www.uerm.edu.ph • Trunkline: (+632) 8-715-0861 loc. 205
Date_____________
Personal Information
Name: BALOCATING, ANNE NICOLE MENDOZA
Permanent Home
#24 NAZARENE ST. TIERRA VISTA SUBD. PARANG, MARIKINA CITY, 1809
Address:
Current Address: #24 NAZARENE ST. TIERRA VISTA SUBD. PARANG, MARIKINA CITY, 1809
Landline
Mobile Number: 09062003421 N/A Email: annenicolebalocating0103@gmail.com
Number:
Parents
Father Mother
PHILIPPINE NATIONAL POLICE, CAMP 12F SOLARIS ONE BLDG. DELA ROSA ST. LEGASPI VILLAGE,
Office Address: Office Address:
CRAME, QUEZON CITY MAKATI CITY 1226
Permanent Home
#24 NAZARENE ST. TIERRA VISTA SUBD. PARANG, MARIKINA CITY
Address:
Address: #24 NAZARENE ST. TIERRA VISTA SUBD. PARANG, MARIKINA CITY
Character References:
Degree: B N/A,
Schools Attended:
Inclusive years:
Elementary: ST. SCHOLASTICAS ACADEMY OF MARIKINA
2007 - 2014
Inclusive years:
Junior High: ST. SCHOLASTICAS ACADEMY OF MARIKINA
2014 - 2018
Inclusive years:
Senior High: ST. SCHOLASTICAS ACADEMY OF MARIKINA
2018 - 2020
Inclusive years:
College: N/A
N/A
Address: N/A
N/A
Sports Festival Bronze Medalist for Tug-O-War (Junior High grade 9), , Sports Festival Gold Medalist for Art Relay (Junior High grade 10), , Sports Festival
Silver Medalist for Kickball (Senior High grade 11)
Name of school:
MOTHER FATHER
Class: Class:
College: College:
Financial Information
How do you plan to finance your education? Please indicate in percentage (%)
*2020005147*
SIGNED DECLARATION BY THE APPLICANT
1. I hereby certify that:
a. I have NOT withheld any information from this application that might prevent my admission.
b. I have PERSONALLY filled out this form and that to the best of my knowledge, all the information contained herein are
COMPLETE and ACCURATE.
c. I have NOT been debarred from other schools.
2. I hereby pledge that:
a. My enrolment will be automatically canceled if UERMMMCI finds out that I have provided false information or documents to support
my application for admission;
b. If admitted to UERMMMCI, I will comply with all the rules and regulations now in effect or which hereinafter may be formulated;
c. I will join only in campus organizations recognized by UERMMMCI.
3. I hereby agree and understand that this form and all documents submitted in support of my application for admission becomes the
property of UERMMMCI and will be retained and disposed of according to its retention and disposal policies.
4. If accepted, I hereby authorize UERMMMCI to publish my name in their bulletin board and/or websites for any relevant co-curricular and
academic issues/events.
5. I authorize UERMMMCI and its personnel to process all information I provided, including collecting, recording, organizing, storing,
retrieving, consolidating, sharing or using the information and/or documents provided in any other way necessary to pursue its legitimate
interests in relation to my application for admission. I understand that UERMMMCI may keep my information for historical and statistical
purposes.
6. I will voluntarily submit myself to an annual physical examination; I further understand that failure to do so in any school year during my
attendance in the university will result to my conditional enrolment, subject for completion within a period prescribed by UERMMMCI.
7. I understand that in relation to CHED Memorandum Order (CMO) No. 18 series of 2018, I will voluntarily submit myself to undergo
mandatory drug testing, if needed. I agree to shoulder any related cost that may arise in performing the mandatory drug testing, if not
funded by the government.
*2020005147*
*2020005147*