BROKENSHIRE COLLEGE

Madapo, Davao City 8000

www.brokenshire.edu.ph

APPLICATION FOR ADMISSION

Attach 2 x 2
Picture
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Please fully accomplish this form and submit it to the Admission Officer
of Brokenshire College, Madapo, Davao City, 8000, Philippines.

Name:
___________________________________________________________________________________
(Last) (First) (Middle)
Desired Course: First Choice:________________ Second Choice:________________ Third Choice: __________________
College Admission Test Result:
Overall Rating: _______________ Recommended to take: English Plus:_______________ Math Plus: _____________
High School General Average Grade/WPA grade for transferees and
professionals:__________________
Home Address: __________________________________________________________________________________
Date and Place of Birth:_________________________________________________ Gender: ________________
Civil Status: _____________ Citizenship: ________________ Religious Affiliation: ______________________
Contact Number: _____________________________________
Family Background (must be completed):
Father’s Name: _______________________________ Date of Birth:__________________ Occupation: ____________
Educational Attainment:_______________________________________________________________________________
Citizenship:_________________________ Name of Firm/Company: ________________________________________
Business Address: ______________________________________________________ Contact No.:__________________
Mother’s Name: _____________________________ Date of Birth: __________________ Occupation: ____________
Educational Attainment: _____________________________________________________________________________
Citizenship: ________________________ Name of Firm / Company: _______________________________________
Business Address:_____________________________________________________ Contact No.: __________________
No. Of Children in your family: ________________ No. Of Children in College:______________________
No. Of Children who have attended College: _____________________

Children in the family including yourself (your brothers and sisters):

Name Highest Degree School Inclusive Year
Attained Attended Years
Graduated
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
_________________________________________________________________________________________________________

List of schools attended (Elementary School up to College, if applicable):

School Location Dates of Year Certificate /
Attendance Graduated Degree Earned
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
_________________________________________________________________________________________________________
Degree you wish to earn in Brokenshire College: _______________________________________________________
Earliest date you wish to enter Brokenshire College: ___________________________________________________
Condition of health (check one): ( ) Excellent ( ) Good ( ) Fair
State nature of defects, if any: _______________________________________________________________________
If foreigner, accomplish all the requirements for foreign students.

Entrance Exam Fee: P150.00 for Regular Students / P75.00 for UMP and EC
P450.00 for BSN Transferees and Professionals
What was your reason in choosing Brokenshire College among other schools in Davao City?
( ) Quality Education ( ) Job Opportunities for graduates ( ) Prestige of the School
( ) Good Facilities ( ) Good environment ( ) Competitive Teachers
( ) Others, Specify: ____________________________________

Who / What influenced you to study in Brokenshire College? (Please describe other factors):
( ) Parents ( ) Recruiter ( ) Brochure _______________________________
( ) Alumni ( ) College ( ) TV / Radio Ads _______________________________
( ) Letter Publication (LAMP) ( ) School of Origin _______________________________
( ) Faculty/Staff ( ) Poster ( ) Friend _______________________________
( ) School ( ) Student ( ) Relatives _______________________________
Campaign
Monthly salary (for UMP Applicants only):
_______________________________________________________
Nature of work / Job Description: ________________________________________________________________
Employers Address:
______________________________________________________________________________

Annual Income: Please check the appropriate box.

Below P50,000 P130,000.00 – 139,000.00

P50,000.00 – 59,999.99 P140,000.00 – 149,000.00
P60,000.00 – 69,999.99 P150,000.00 – 159,000.00
P70,000.00 – 79,999.99 P160,000.00 – 169,000.00
P80,000.00 – 89,999.99 P170,000.00 – 179,000.00
P90,000.00 – 99,999.99 P180,000.00 – 189,000.00
P100,000.00 – 109,000.00 P190,000.00 – 199,000.00
P110,000.00 – 119,000.00 P200,000.00 – 209,000.00
P120,000.00 – 129,000.00 P210,000.00 – and above

Will you live in the dormitory? If yes, what type of accommodation?

Yes No Regular Cooperative

If no, where will you stay? (Specify name and address)

Relative or Friend Employer Boarding House
___________________________ ___________________________ ______________________________
___________________________ ___________________________ ______________________________
___________________________ ___________________________ ______________________________

The above information is true and correct. Once admitted in Brokenshire College, I hereby
accept and abide by the rules and regulations of the School.

_______________________________ ________________________________
Date Signature of the Student

FOR THE PARENT OR GUARDIAN

I, _____________________________________________ of _______________________________
hereby approve the application of son / daughter / ward, for admission at Brokenshire
College and hereby accept and agree to abide by the rules and regulations of the School.

____________________________ ______________________________
Date Signature of Parent/Guardian

FRM – REG – 43A

Rev. No. : 3

Entrance Exam Fee: P150.00 for Regular Students / P75.00 for UMP and EC
P450.00 for BSN Transferees and Professionals