ST.

BERNADETTE OF LOUR DES COLLEGE

COLLEGE OF NURSING

(Do not fill this block)

General Weighted Average _______________ Entrance Examination _______________________

Interview Rating _______________ Remarks __________________________________
_________________________________________

Application will not be processed if all blanks will not be filled out completely and required documents are
submitted. False information automatically invalidates the application.

Admission to the St. Bernadette of Lourdes College of Nursing is based on merits and on the compliance to the
criteria established by the committee on admission of the school.

Please do not fall prey to unscrupulous personnel / individuals who will offer their help to facilitate your
admission to the College of Nursing of any financial / material considerations. We shall appreciate your reporting to the
Dean’s Office of such attempt. We also discourage an applicant wishing admission from offering gift/s of any kind to
anybody connected to the school.

I hereby certify that I have read carefully all the foregoing and if admitted, I shall observe and follow all the
regulations and policies promulgated by the St. Bernadette of Lourdes College Inc.

_______________________________
Signature of Applicant

Received by: ___________________

Date : __________________

SBLC-ADM (2)
3-20-04
 ST. BERNADETTE OF LOUR DES COLLEGE
COLLEGE OF NURSING
APPLICATION FOR ADMISSION
FIRST SEMESTER 200_-200_
1. Name (Please Print) ___________________________________________________________________________
SURNAME GIVEN NAME MIDDLE NAME

2. Address ____________________________________________________________________________________
3. Date of Birth ____________________________ 4. Place of Birth _________________________ _

5. Religion ______________________________

6. Age ___________ 7. Sex _________ 8. Height (cm) _____ 9. Weight (kg) _______

10. Civil Status _______________ 11. Nationality and Citizenship ______________________________

12. Educational Attainment:

LEVEL OF SCHOOL/UNIVERSITY ADDRESS INCLUSIVE DATE HONORS

EDUCATION RECEIVED

A. Elementary
Grade I-IV

Grade V-VI

B. Secondary

EXTRA CURRICULAR ACTIVITIES:

13. Father’s Name ___________________________ Occupation ________________________

14. Mother’s Name __________________________ Occupation ________________________
15. Parent’s Address _______________________________________Telephone Number __________________
16. Have you applied for admission in other institutions? Yes ________
No ________
17. Are you transferring from another school? Yes ________No _________
18. Degrees Earned _______________________________________________
19. School and Year Graduated ______________________________________