ASGC ENROLLMENT FORM

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Email* This field is required.
example@example.com
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Terms and Conditions* This field is required.In compliance with the provisions of RA 10173, also known as Data Privacy Act of 2012, we would like to inform you that we collect data such as names, birthdates, addresses and other identifiable information as you proceed with your enrollment process. Rest assured that the data we collected shall be kept in greatest confidentiality and will be stored electronically or in any other means. They shall be retrieved only by authorized persons and shall be used for school purposes only. Thank you for your trust at Academia in handling your data privacy
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Learner's Reference Number (LRN)* This field is required.
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Grade Level* This field is required.
Grade 11
Grade 12
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Strand* This field is required.
General Academic Strand (GAS)
Humanities and Social Sciences Strand (HUMSS)
Science, Technology, Engineering and Mathematics (STEM)
Accountancy, Business and Management (ABM)
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Shift* This field is required.
Morning (6AM- 12NN)
Afternoon (12NN–6PM)
Evening (6PM–10PM)
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Name* This field is required.
First Name
Middle Name
Last Name
Suffix: Jr, Sr, II, and III.
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Date of Birth* This field is required.
Date
Year
Month
Day
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Age* This field is required.
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Gender* This field is required.
Male
Female
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Religious Affiliation* This field is required.
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Complete Address* This field is required.Zip Codes: Cebu City (6000) Talisay (6045) Minglanilla (6046) Naga (6037)
House number or Lot/Block/Phase/Subdivision Name/Sitio/Purok
Barangay
City/Municipality
Province
Zip Codes
Please Select
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curacao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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Phone Number* This field is required.
+63
Phone Number
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Do you have a gadget (smart cellphone, tablet, laptop, personal computer) that you will use for our online classes?* This field is required.
YESNO
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Will you avail of the free cellphone which academia will give you for our online classes?* This field is required.
YESNO
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Facebook AccountPlease paste URL of your account. In your Facebook account, click profile, and copy URL in the address bar.
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Name of Last School Attended* This field is required.
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Address of Last School Attended* This field is required.
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Year Graduated* This field is required.
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
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Date of Enrolment* This field is required.
Date
Year
Month
Day
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Father's Full Name* This field is required.
Mr., Dr., Atty., Capt.
First Name
Last Name
Suffix
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Mother's Maiden Name* This field is required.
Mr., Dr., Atty., Capt.
First Name
Middle Name
Last Name
Suffix
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Notice* This field is required.I hereby certify that the above information I have provided are true and correct. I attest to abide all school policies and regulations and that I will submit all the requirements needed for this enrolment. I understand that as an enrolled student in Academia, I will no longer enroll in another school or institution.
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Signature
Clear
Should be Empty: