Registry Area - ACC QPS

Pre Registration Form

Student Profile

Learner Register Number (LRN)

First Name*

Last Name*

Middle Name*

Maiden Name

Suffix

Date of Birth*

Place of Birth*

Gender*

Civil Status*

Nationality*

Religion*

DSWD Household no.*

Household Income (Monthly)*

Disability*

Facebook Accnt*

Home Address (Region)*

Home Address (Province)*

Home Address (Municipality)*

Home Address (Barangay)*

Zip Code*

Email*

Preferred Course / Program*

Boarding House Address*

Family / Guardian Background

Mother's Last Name*

Mother's First Name*

Mother's Middle Name*

Mother's Address*

Mother's Occupation*

Father's Last Name*

Father's First Name*

Father's Middle Name*

Father's Suffix

Father's Address*

Father's Occupation*

Guardian Name*

Guardian Address*

Guardian Occupation*

Parents Contact Number*

Student Contact Number*

Please provide an active contact number. Notifications will be sent here.

Educational Background

Primary School (Grade 1-4)*

School Address (Grade 1-4)*

Inclusive Year (Grade 1-4)*

Elementary School (Grade 5-6)*

School Address (Grade 5-6)*

Inclusive Year (Grade 5-6)*

Junior High School (Grade 7-10)*

School Address (Grade 7-10)*

Inclusive Year (Grade 7-10)*

Senior High School (Grade 11-12)

School Address (Grade 11-12)

Inclusive Year (Grade 11-12)

College

College Address

College Inclusive Year

Others

Other School Address

Other Inclusive Year

Last School Attended

Last School Address

Inclusive Year

Username* Username must start with a letter, combination of alphanumeric,and must 6 character & above.

Password*

Have you received your Covid-19 Vaccination?*

YES

Upload Picture for Validation*

The photo must be 2x2 in size in plain white background.

Note: Applicant must not wear mask/eyeglasses, photo does not resemble applicant to avoid disapproval of pre-registration.

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Pre Registration Form

Student Profile

Family / Guardian Background

Educational Background

Terms and Conditions