ONLINE REGISTRATION FORM
Greetings from Visayas State University Alangalang Campus! This form serves as your registration for Summer, SY 2021-2022. Please accomplish this form religiously and honestly USING CAPITAL LETTES and please do not leave an item unanswered except if not applicable. Moreover, Visayas State University Alangalang upholds individual data privacy rights and assures that all your personal information, sensitive personal information and privileged information (collectively, “Personal Information/Data”), collected and to be collected, are processed in compliance to the Data Privacy Act of 2012 (RA No. 10173) and its Implementing Rules and Regulations (IRR).
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Email *
STUDENT NUMBER *
MOBILE NUMBER(Please provide an ACTIVE number where you can be contacted.) *
EMAIL ADDRESS *
LAST NAME *
FIRST NAME *
MIDDLE NAME(TYPE NA IF NONE) *
SEX *
SUFFIX (e.g. Jr.)
DATE OF BIRTH (mm/ddyyyy) *
MM
/
DD
/
YYYY
CIVIL STATUS *
If Married, type FULL NAME OF SPOUSE AND CONTACT NUMBER.
FATHER'S NAME (Last Name, First Name, Middle Name) *
MOTHER'S MAIDEN NAME (Last Name, First Name, Middle Name) *
GUARDIAN'S NAME (Last Name, First Name, Middle Name)
PARENT'S/GUARDIAN'S EMERGENCY CONTACT NUMBER *
ESTIMATED MONTHLY INCOME(PARENTS') *
ADDRESS- BARANGAY (Name of barangay only) *
ADDRESS- MUNICIPALITY *
ADDRESS- PROVINCE *
DEGREE PROGRAM *
Required
YEAR LEVEL *
Required
SECTION *
Required
ACADEMIC STATUS *
Required
STUDENT STATUS *
Required
VACCINATION STATUS *
Required
VACCINE TYPE( Check NOT APPLICABLE IF UNVACCINATED) *
Required
ACADEMIC ADVISER *
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