ACI

COLLEGE ONLINE REGISTRATION
SY: 2024-2025 1ST SEMESTER
(NEW STUDENTS ONLY)

INSTRUCTION: Please fill-out all details for your Registration. Put NA if some fields are not applicable.

Note : Indicate required field ( * )

First Name *

Middle Name *

Last Name *

Suffix

Learner's Ref Number *

Select Student Type *

COURSE YEAR

Course *

Year Level *

PERSONAL INFO

Gender *

Civil Status *

Birth Date *

Birth Place *

Nationality *

Religion *

Ethnicity *

EDUCATIONAL BACKGROUND

Preschool *

School Year *

Elementary *

School Year *

Junior High *

School Year *

Senior High *

School Year *

Alternative Learning System ( ALS ) *

School Year *

College *

School Year *

CONTACT & ADDRESS

Mobile Phone *Please provide a valid Mobile Number for Confirmation

Permanent Address *

House No. / Street / Subdivision / Building *

Province *

City *

Barangay *

Check if current address is the same with permanent address.

Current Address *

House No. / Street / Subdivision / Building

Province

City

Barangay

SOCIAL MEDIA ACCOUNTS

PARENTS

Father's Name *

First Name

Middle Name

Last Name

Father's Phone No. *

Father's Occupation *

Mother's Maiden Name *

First Name

Middle Name

Last Name

Mother's Phone No. *

Mother's Occupation *

Guardian's Name

First Name

Middle Name

Last Name

Guardian's Phone No. *

Guardian's Occupation *

ADDITIONAL INFORMATION

SCHOLARSHIP (If applicable)

Type of Scholarship/Grant Availed:

CHED Tulong-Dunong

LGU Butuan

Student Assistant

Amount Granted

Award Number

HEALTH PROFILE

ACADEMIC/RELIGIOUS/SPORTS/COMMUNITY CLUBS AND ORGANIZATIONS

Are you a member of any gov't sponsored organization/program? Specify name of organization/program *

Are you a member of any non-gov't sponsored organization/program? Specify name of organization/program *

Do you receive any benefits from this organization/program? Please specify *

PERSONAL CONCERNS

Health/Physical Problems *

Behavior/Mental Concerns *

Disability *

Form 138 (Front)

Form 138 (Back)

Undertaking

OTR

Form 137A

Good Moral Certificate

ALS Report Card

Birth Certificate

ALS A&E Certificate

Permit to Cross-Enroll

TOR

ONLINE CLASS SURVEY

I'M CAPABLE FOR ONLINE CLASS

I'M NOT CAPABLE FOR ONLINE CLASS

I confirm that the information I have given in this form is true, complete and accurate. I agree to fill-out this Student Information Form (SIF) and hereby authorize sharing of the information furnished on this form with AGUSAN COLLEGES, INC. in accordance with the Philippine Data Privacy Act of 2012.

AGUSAN COLLEGES, INC.