SRMS | Online Registration

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Before submitting: You may print this form to keep a copy of your registration. Print then submit when you're ready.

Personal Information

First Name *

Middle Name

Last Name *

Name Extn.

Sex *

Civil Status *

Birth Date *

Age *

Birth Place *

Mobile No. *

E-mail Address *

Vaccination Status

Working Student *

Learner Reference Number (LRN) * Enter your 12-digit Learner Reference Number.

Ethnicity *

Religion *

Address

Province *

City/Municipality *

Barangay *

Sitio

Spouse Information

Spouse Name

Relationship

Spouse Contact No.

Children

Parents & Guardian

Father

Father's Name *

Occupation *

Contact No. *

Mother

Mother's Name *

Occupation *

Contact No. *

Guardian

Guardian Name

Relationship

Address

Contact No.

Special Status

PWD? *

IP? *

Single Parent? *

Preferred Course / Program

Course / Program *

Major Select a course first.

Educational Background

Elementary

School Name *

School Address *

A.Y *

Junior High School

School Name *

School Address *

A.Y *

Senior High School

School Name *

School Address *

A.Y *

Vocational (if any)

School Name

School Address

Course

A.Y

Last School Attended

School Name * Select a school or type one if it is not listed.

School Address *

A.Y *

Data Privacy & Consent

Data Privacy Notice

Please read before submitting your registration.

I have read and understood the Data Privacy Notice and I consent to the collection and processing of my personal data.

Checklist of Requirements

2 PCS 2X2 PICTURE

FORM 137 - PERMANENT SCHOOL RECORD

FORM 138 - STUDENT REPORT CARD

GOOD MORAL

HONORABLE DISMISSAL

PSA BIRTH CERTIFICATE

TRANSCRIPT OF RECORDS

Data Privacy Statement

I hereby certify that the information provided in this registration form is true, correct, and complete to the best of my knowledge. I understand that AMYA POLYTECHNIC COLLEGE, INC. may collect, process, store, and verify my personal information for admission, enrollment, records management, student applicant evaluation, and other lawful school purposes in accordance with the Data Privacy Act of 2012 and its implementing rules and regulations.

By signing below, you affirm that you have read and understood this Data Privacy Statement and voluntarily grant AMYA POLYTECHNIC COLLEGE, INC. your consent to collect and process your personal information for the purposes stated herein.

Student Name and Signature