A. Personal Record
Family Name *
First Name *
Middle Name *
Nickname
Age *
Date of Birth *
Place of Birth *
Sex * Male Female
Marital Status * Single Married Widowed Separated
Citizenship *
Religion *
Present Address *
Provincial Address *
Telephone *
Mobile *
E-Mail *
Occupation *
Company *
Telephone *
Name of Spouse *
No. of Children *
Occupation *
Company *
Telephone *
Educational Attainment * College Graduate Undergraduate Vocational Graduate High School Graduate
Course/Degree
NCII Certificate/s
University/College/School *
Year Graduated *
Caregiving NCII
Health Care Services NCII
Licensed Practical Nursing NCII
Barangay Health Services NCII
Emergency Medical Services NCII
Pharmacy Services NCII
Massage Therapy NCII
Hilot (Wellness Massage) NCII
Housekeeping NCII
Household Services NCII
Japanese Language
ESL Courses
Other Courses (please specify)
D. Additional Information
How did you come to know about CHP Cebu? Streamers/Signage Friends/Relatives Leaflets/Pamphlets Website (www.chpcebu.com) Search Engine (Google) Newspaper (Sunstar/Freeman/Super Balita) Others
If Others, please specify
How will your studies be financed? Self Parents Relatives Employer Others
If Others, please specify
Terms of Payment Outright Cash Installment
If Installment, I will settle all tuition & related fees within no. of months
I certify that the statements made by me herewith are complete and true to the best of my knowledge and belief. I understand that any misstatement may lead to disqualification or dismissal. *
0 + 4 = ? Please prove that you are human by solving the equation *
