St. Luke’s College Medical Center of Medicine William H. Quasha MemorialSta. Ignaciana Street Cathedral Heights, Quezon City

Telephone Nos.: 727•7610 / 723•0301 local 3808Email Address: registrar@stlukesmedcollege.edu.ph

website: www.stlukesmedcollege.edu.ph

APPLICATION FORM

Be a Lukan M.D.

St. Luke’s Medical Center College of Medicine Requirements

1. Application form duly accomplished with two (2) 2”x2” colored recent photographs with a white background.

3. If a foreigner or foreign Graduate: Please refer to the SLMCCM- WHQM website for application requirements for foreign students and foreign graduate.

6. If a foreigner or foreign Graduate: Please refer to the SLMCCM- WHQM website for application requirements for foreign students and foreign graduate.

• Failure of more than Ten (10) units from the previous school.• General Weighted Average (GWA) lower than 2.5 or its equivalent.

2. Original/Certi�ed True Copy of the following: A.) Transcript of Records (with General Weighted Average) • Graduate with a Bachelor’s degree, and preferably earned the following units: a.1) 15 units of Biology (Botany, General Zoology, General Biology, Parasitology, Physiology and Vertebrae Comparative Anatomy); a.2) 10 units of Chemistry (General Chemistry, Analytical Chemistry, Organic Chemistry, and Bio-Chemistry); a.3) 9 units of Mathematics (Algebra, Trigonometry, Pre-Calculus, Calculus or Statistics); a.4) 5 units of Physics (General Physics) a.5) 12 units of Social Sciences

B.) Certi�cate of expected graduation. C.) NMAT result (not lower than 90 percentile rank). D.) Birth Certi�cate (NSO or PSA authenticated). (If Married: Marriage Certi�cate) E.) Two (2) Certi�cates of Good Moral Character from any of the following: Dean, Guidance Counselor, Student Affairs, College Secretary, or Registrar.

1. Application form duly accomplished with two (2) 2”x2” colored recent photographs with a white background.

3. Satisfy admission requirements set for regular 1st year applicants

4. Within the upper 20% of his/her batch.

5. No failure in any subject.

Scholarships may be offered to graduates of colleges or universities with the following credentials, subject to the evaluation and approvalof the Scholarship Committee:

1.) NMAT percentile rank of 95% or higher. 2.) Magna or Summa Cum Laude. 3.) No failure in any subject.

ORIGINAL copies of the following: • Transfer credentials • Of�cial Transcript of Records with remarks “Graduated”

2. Original/Certi�ed True Copy of the following: • Transcript of Records (College and Medicine I) • Certi�cate of Eligibility for Medicine (CEM) • Transfer credentials • Certi�cate of Ranking • NMAT result (not lower than 90 percentile rank) • Birth Certi�cate (NSO or PSA Authenticated). (If Married: Marriage Certi�cate) • Two (2) Certi�cates of Good Moral Character from any of the following: Dean, Guidance Counselor, Student Affairs, College Secretary, or Registrar.

FRESHMEN TRANSFEREE

RESTRICTIONS ON ADMISSION

SCHOLARSHIP ELIGIBILITY

ADDITIONAL REQUIREMENTS FOR ENROLLMENT

APPLICATION FEES

APPLICANT

LOCAL

*FOREIGN / STUDENTS WHO GRADUATED ABROAD

*Endowment of $10,000.00 (non-refundable) upon enrollment, towards SLMCCM-WHQM Institutional Development Fund.

PROCESSING FEES (NON-REFUNDABLE)

October 1, 2018 toMarch 29, 2019

March 29, 2019 onwards

Php 3, 500.00

$ 350.00

Php 3, 000.00

$ 300.00

St. Luke’s Medical Center College of Medicine William H. Quasha MemorialSta. Ignaciana Street Cathedral Heights, Quezon City

Telephone Nos.: 727•7610 / 723•0301 local 3808Email Address: registrar@stlukesmedcollege.edu.ph

website: www.stlukesmedcollege.edu.ph

APPLICATION FORM

Date

Application Number

St. Luke’s Medical Center College of Medicine (Doctor of Medicine Program)

NAME

PERMANENT ADDRESS

PLACE OF BIRTH

DATE OF BIRTH

TEL. NO.

FATHER

OCCUPATION

CONTACT NO.

CITIZENSHIP GENDER AGE

ZIP CODE

CIVIL STATUS

MOBILE NO. EMAIL ADDRESS

CITY

RELIGION

(Last Name, First Name, M.I.)

I certify to the veracity of the above information, any evidence of fraud in the credentials/documents submitted will automatically nullifymy enrollment in the St. Luke’s Medical Center College of Medicine.

I certify further that if accepted, I will abide by all rules and regulations of the College and CHED.

EDUCATION

Be a Lukan M.D.

MOTHER

OCCUPATION CONTACT NO.

GUARDIAN ADDRESS

CONTACT NO.

PRIMARY EDUCATION YEAR GRADUATED

SECONDARY EDUCATION YEAR GRADUATED

TERTIARY EDUCATION YEAR GRADUATED

PRE-MED COURSE YEAR GRADUATED

SCHOOL LAST ATTENDED SCHOOL YEAR

HONORS / AWARDS

Why St. Luke’s Medical Center College of Medicine? Please rank according to importance.

Have you applied in other medical school(s)?

[ ]No [ ] Yes

(1 = most important; 6 = least important)

*For those with a gap between graduation and medical school application please provide details.

Curriculum

School

School

Reputation

Scholarship Opportunity

Career Opportunity

Facilities

Others

Have you ever been enrolled in other medical school(s)?

[ ]No [ ] YesDate / School Year

Signature of ApplicantOR No.

Status of Application

Do you need �nancial assistance?

[ ]No [ ] Yes If Yes, please download �nancial aid application form at SLMCCM-WHQM Website.

IF FOREIGN APPLICANT: ACR No. VISA STATUS

IMPORTANT: The application for admission does not mean automatic acceptance to the St. Luke’s Medical Center College of Medicine.

2x2

St. Luke’s Medical Center College of Medicine William H. Quasha Memorial Sta. Ignaciana Street Cathedral Heights, Quezon City

Telephone Nos.: 727•7610 / 723•0301 local 3808Email Address: registrar@stlukesmedcollege.edu.ph

website: www.stlukesmedcollege.edu.ph

APPLICATION FORM

Date

St. Luke’s Medical Center College of Medicine (Doctor of Medicine Program)

I certify to the veracity of the above information, any evidence of fraud in the credentials/documents submitted will automatically nullifymy enrollment in the St. Luke’s Medical Center College of Medicine.

I certify further that if accepted, I will abide by all rules and regulations of the College and CHED.

ESSAY

What skills and experiences do you have which will help you through medical school?

Signature over printed nameOR No.

IMPORTANT: The application for admission does not mean automatic acceptance to the St. Luke’s Medical Center College of Medicine.

Be a Lukan M.D.

St. Luke’s Medical Center College of Medicine William H. Quasha Memorial Sta. Ignaciana Street Cathedral Heights, Quezon City

Telephone Nos.: 727•7610 / 723•0301 local 3808Email Address: registrar@stlukesmedcollege.edu.ph

website: www.stlukesmedcollege.edu.ph

APPLICATION FORM

Date

St. Luke’s Medical Center College of Medicine (Doctor of Medicine Program)

I certify to the veracity of the above information, any evidence of fraud in the credentials/documents submitted will automatically nullifymy enrollment in the St. Luke’s Medical Center College of Medicine.

I certify further that if accepted, I will abide by all rules and regulations of the College and CHED.

DATA SUBJECT CONSENT FORM

How did you come to know about this school? Are you being treated for any medical condition? Yes

If yes, what medications are your currently taking?

Signature over printed nameOR No.

IMPORTANT: The application for admission does not mean automatic acceptance to the St. Luke’s Medical Center College of Medicine.

Be a Lukan M.D.

Open House

Internet

Med Talk

Others

No

In accordance with RA 10173 of Data Privacy Act of 2012, I consent to the following terms and conditions on the collection, use,

processing and disclosure of my personal data:

1. I am aware that St. Luke’s Medical Center College of Medicine-WHQM (“SLMCCM-WHQM”) has collected and

stored my personal data, de�ned under the law as referring to all personal information, in its database during

my application for admission in the Doctor of Medicine Program / Master of Science in Molecular Medicine

Program. These data include my academic records, demographic pro�le, contact details like addresses, email

address, landline and mobile phone numbers.

2. I will personally update these data upon request of SLMCCM-WHQM or as needed.

3. Towards the ef�cient management of the organization’s records, I authorize SLMCCM-WHQM, and its af�liate

of�ces including, but not limited to, the of�ces of the President and Dean, Associate Deans, and Guidance and

Counseling, to manage my data for data sharing with accredited industry partners and government agencies.

4. I agree to have my name posted in the website and bulletin board/s of SLMCCM-WHQM if I get accepted into

any of its academic program offerings.

5. To ensure the protection of my rights as a data subject, de�ned under the law as referring to an individual

whose personal, sensitive personal, or privileged information is processed, I understand that SLMCCM-WHQM

shall warrant to me the following rights:

a. Receive notices on changes in the above-cited purposes for my data processing or personal data breaches

provided for in Section 38 of the Data Privacy Act’s Implementing Guidelines;

b. Upon submission of a notarized letter of request, erase my personal data due to unauthorized processing or

when information is prejudicial to me;

By signing below, I warrant that I have read and understood all of the above provisions and agreed with its full implementation.