OOA Form 1 - 2010

ILOILO DOCTORS’ COLLEGE

West Avenue, Molo Iloilo City
Office of Admission: Fax/Tel. No. (033) 337-00-34
PASTE/STAPLE
O.R. No.: ___________________
AMOUNT PAID:____________
APPLICATION FOR ADMISSION
2x2 SIZE COLORED
PRINT OR TYPE all information and attach two 2x2 photograph as PICTURE
indicated on the right. Submit this form together with the other
requirements to the Iloilo Doctors’ College Admissions Office for
your Entrance Examination schedule.

Application is made as a:
Freshman Student Shifter (student enrolled in IDC during the previous Semester)
Second Courser (graduate of other courses) Transferee (undergraduate from other schools)

Personal Data Enrollment Information

Academic Year (AY) for which you are applying: 20___

Last Name First Name Middle Name
1st Semester 2nd Semester Summer

Any other name(s) used Date of Birth Place of Birth CHECK THE DEGREE PROGRAM YOU WISH TO
On Transcripts and PURSUE:
Other Documents

Doctor of Dental Medicine

Citizenship religion Age
B.S. Physical Therapy
B.S. in Nursing
Permanent Mailing Address B.S. in Medical Laboratory Science
B.S. in Biological Science
M F B.S. in Psychology
Gender: Tel. No. Mobile No.
B.S. in Social Work
B.S. in Radiologic Technology
Civil Status: S M W E-mail Address B.S. in Criminology
B.S.B.A. major in Human Resource Management
B.S.B.A. major in Financial Management
Name of person to Contact in Case of Emergency Relation to Applicant B.S. in Computer Science
B.S. in Information Technology
Address Tel. No. B.S. in Information System
Associate in Radiologic Technology
If Married: Diploma in Midwifery
Certificate in Health Care Services
Name of Spouse Citizenship No. of Children

Educational Background

Previous Schooling Name of School Year Attended

PRIMARY(Grades 1-4)
INTERMEDIATE (Grades 5—6)
HIGH SCHOOL
COLLEGIATE

Are you coming in as a scholar? YES NO

If yes, check appropriate sponsoring agency: CHED TESDA Iloilo City Scholars Others (pls. specify)__________________

Are you interested in applying for any of the IDC scholarship programs? YES NO
If yes, please check the scholarship that you are applying for:
___Entrance Scholarship ___Honor Student Scholarship ___AFP Educational Benefit System

___IDC Chairman Scholarship Grant ___IDC President Scholarship Grant ___Director/Stockholder Scholarship Grant ___Working Student

Athletic Scholarship:___Volleyball ___Basketball (men) ___Swimming ___Table Tennis ___Chess ___Badminton ___Karatedo

Have you ever applied to this college? YES NO If YES, when? Semester____________ Year__________

Have you ever attended this college? YES NO If YES, when? Semester____________ Year__________

Honors/awards/distinctions received

______________________________________________________________________________________________________________________________________________________________

If you have not pursued your education from date of graduation from high school to the present, state reasons why?

______________________________________________________________________________________________________________________________________________________________
 PERSONAL DATA SHEET Program: ______________________

Student #: _____________________

Last Name First Name Middle Name Auxiliary Name

(Sr.,Jr.,I,II,III, etc.)
City Address:_______________________________________________________________________________________________________________________________

Postal Code:______________ Tel. No.:____________________________ E-mail Address:_________________________________

Home Address:__________________________________________________________________________________________________________

Postal Code:______________ Region:____________________ Citizenship:_____________________ Religion:______________

Date of Birth:__________________ Age:______ Place of Birth:_________________________________ Gender: M F

If Alien, ACR # (see Registrar):______________________

Civil Status: Single Are you currently employed? YES NO

Married If working: Office/Bus. Tel. #:_______________
Divorced
Widowed Status of Employment: Part-time Full-time
Separated Employer:_______________________________

FATHER’S INFORMATION: MOTHER’S INFORMATION:

Last Name:_______________________________________________ Last Name:______________________________________________

First Name:______________________________________________ First Name:_____________________________________________

Middle Name:____________________________________________ Middle Name:____________________________________________

Occupation/Employment:______________________________ Occupation/Employment:______________________________

Educational Attainment:_______________________________ Educational Attainment:________________________________

Address:________________________________________________ Address:_________________________________________________

Tel. No.:_________________________________________________ Tel. No.:_________________________________________________

BROTHERS & SISTERS (Please list from Eldest to Youngest)

NAME AGE CIVIL ADDRESS & Contact No.
STATUS

I certify that the information given herein is correct and complete. Falsification or withholding of information on
this form will automatically nullify my application and/or subject me to dismissal from the college.

Student’s Signature over Printed Name Date

YOUR APPLICATION IS VALID ONLY FOR THE SEMESTER STATED AT THE FRONT
DO NOT FILL-UP. FOR OFFICE PERSONNEL ONLY
Pre-admission Requirements Submitted: Interview Evaluation: Score: (Please check one)
High School Graduate: 5 4 3 2 1
A. Personality/Physical Appearance
___HS Card
___Cert. of GMC B. Command of language
___Birth Certificate
C. Maturity of Outlook/Attitude towards
Transferees/Second Coursers 1. Service
___TOR
___Transfer Credentials 2. Authority
___Cert. of GMC
___Birth Certificate D. Punctuality
___Assessment of Grades by IDC Registrar Remarks: ________________________________
___Marriage Certificate __________________________________________
(for married Female applicants only)
Interviewer:_____________________________
H.S. Gen. Average: ______________ Date:___________________
Entrance Exam Score:____________

ENROLLMENT CLEARANCE:
COURSE:_________________________________ ___________________________________________
DEAN

Approved for Enrollment: FRANCIS D. LAUREA

Director for Admission
 ILOILO DOCTORS’ COLLEGE
West Avenue, Molo Iloilo City
Office of Admission: Fax/Tel. No. (033) 337-00-34

STUDENT EXIT INTERVIEW

Student Name________________________________ Withdrawal Date_______________

Course______________________________________ Year Level____________________

1. What is the primary reason the students is terminating school enrollment? (check one)

____Failing Grades ____Family Problem

____Illness ____Student/Teacher Conflict
____Expelled ____Truancy/Absenteeism
____Financial ____Did not like the course

2. Nature and quality of course and teaching experience as a student.

____Excellent ____Good _____Fair ____Poor

3. Academic resources and facilities:

____Excellent ____Good _____Fair ____Poor

4. Student support services:

Dean’s Office : ____Excellent ____Good _____Fair ____Poor

Office of Student Affairs: ____Excellent ____Good _____Fair ____Poor
Registrar’s Office : ____Excellent ____Good _____Fair ____Poor
Guidance Office : ____Excellent ____Good _____Fair ____Poor
Library : ____Excellent ____Good _____Fair ____Poor
Health Services : ____Excellent ____Good _____Fair ____Poor
Office of Admissions : ____Excellent ____Good _____Fair ____Poor

5. What positive experiences do you have at Iloilo Doctors’ College?

_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________

6. What negative experiences do you have at Iloilo Doctors’ College?

_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________

7. What, if any, concerns do you have about the education at Iloilo Doctors’ College,
and what suggestions do you have for improvement?
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________

___________________________________
Signature over printed name of Interviewer