DON CARLOS POLYTECHNIC COLLEGE -

PRE-REGISTRATION FORM

Last School Attended

School Name

The Last School field is required.

LRN

Personal Information

Last Name The Last Name field is required.

First Name The First Name field is required.

Middle Name The Middle Name field is required.

Suffix Name

Nick Name The Nick Name field is required.

Birthday

Civil Status

Citizenship The Citizenship field is required.

Religion

Gender

Tribe The Tribe field is required.

Body Index

Birth Place

Province

Municipaly/City

Home Address

Province

Municipaly/City

Contact Information

Contact No.

Social Account

Contact Person

Father

Mother

Contact Person

Educational Background

Primary Education

Secondary Education

I Agree, To give my consent to the collection, processing, and disclosure of my personal information to the Admissions Office of the DON CARLOS POLYTECHNIC COLLEGE (DCPC) in accordance with R.A. 10173 ( Data Privacy Act of 2012).