Student Registration Form

ACME CITY COLLEGE
123 Maple Street, Houston, TX, 77002
example@example.com
www.example.com
(123) 1234567
Student Registration Form

Basic Information
Full Name
First NameMiddle NameLast Name
Student Number
e.g. 11183021
Year Level
for Incoming A.Y. '12-'13
Degree Program
Email
Phone Number
Network Provider
Birth Date
MonthDayYear
Present Address
Street Address
Street Address Line 2
CityState / Province
Postal / Zip CodeCountry
Permanent Address
Street Address
Street Address Line 2
CityState / Province
Postal / Zip CodeCountry
Emergency Contact
First NameLast Name
Relationship
ex. Father, Mother, etc.
Address Of Person To Contact In Case Of Emergency
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code
Phone Number Of Person To Contact In Case Of Emergency
Please enter a valid phone number.
Email Of Person To Contact In Case Of Emergency
example@example.com

Academic Background
High School Name
Curriculum Vitae or List of Achievements
File should be in pdf, doc/docx format.
Cancelof
Other Extra Curricular Activities
Extra Curricular Participation
Student CouncilClass OfficerClub/OrganizationVarsity PlayerOthers (please specify below)

Other Details
Resources Available
Car/TransportationEvent Venue/HousePrinterLCD ProjectorLaptop
Skills/Talents
ActingArts/CraftsCalculatingDancingDebatingDrawingEatingFashionPhotographyPlaying drumsPlaying guitarPlaying pianoProgrammingSingingWritingOthers (specify below)
Sports
BadmintonBasketballBowlingChessFrisbeeScrabbleSoccerSoftballSwimmingTable TennisTrack and FieldTennisVolleyballOthers (specify below)
Interests
Estimate Your Family Monthly Income
Do You Have Any Scholarship?
YesNo
Who/what is the name of your sponsor?
Do You Plan To Shift To Another Course?
YesNo
To What Course?
What Course Is Your First Choice In The University?
What Is Your Plan After College?
Suggestions / Comments
Please verify that you are human*
Should be Empty: