Basic Education Application Form

Walk In (Admissions Office)

Online (Outside SDCA)

How did you know about SDCA?

Referral Name

Level Applied

Learner Reference Number (LRN No.)

1. Personal Information

First Name

Last Name

Gender

Mobile Number (ex. 09*********)

Middle Name

Birth Date

Email Address

2. Guardian's Information

Guardian's Name

Email Address

Relation to child

Cellphone Number (ex. 09*********)

3. Address

House No.

Subdivision

City

Street

Province

Barangay

4. Last School Attended

Elementary Level

Name of School and Address

Years Attended

Junior Level

Name of School and Address

Years Attended

5. Other Information

Do you have any physical and/or psychological condition/s that we should be aware of for your welfare?

Personal Information
First Name	First Name	Middle Name	Middle Name
Last Name	Last Name	Birth Date	Birth Date
Gender	Gender
Mobile Number	Mobile Number	Email	Email
Address
House Number	House Number	Street	Street
Subdivision	Subdivision	Province	Province
City	City	Barangay	Barangay
Zip Code	Zip Code
Application Information
Level Applied	Level Applied	Learner Reference Number	Learner Reference Number

Terms and Condition

I of legal age, hereby voluntarily and knowingly authorize St. Dominic College of Asia to collect, process or release my personal and sensitive information that may be used for internal and external school official and legal transactions. I agree on the following conditions:

Personal Information will be released unless written notice of revocation is received by the Data Privacy Office of St. Dominic College of Asia.
Personal information may be released for school official and legal purposes only.
Sensitive information will be kept confidential unless the school deemed it necessary to release on valid and legal purposes only.
Updating and modifying of incorrect, inaccurate or incomplete personal information will be done upon submission of letter of request to St. Dominic College of Asia.
St. Dominic College of Asia and its officials and employees are not held liable for the collection and release of any information that I voluntarily provided.

Fill out completely and Legibly all the information needed. Any false statement, misterpretation or material omission made herein shall be considered as gross dishonest/fraud and will be ground for your disqualification, suspension, dismissal, expulsion or dropping of your name from the rolls of the school.

I agree to the Data Privacy Act Terms and Conditions