STUDENT'S APPLICATION FORM Examinee Code No.

:
F-NTMA-001
Application for Academic Year 20___to 20___
TEST CENTER NO. REGISTRATION NO.

INSTRUCTIONS: Write legibly using a ballpen and in capital letters. Put a check ( ) on the boxes, as applicable and
state N/A if not applicable.
Please write your personal information as what appears in your NSO/PSA-certified birth certificate.

Name :

Last Name, First Name Middle Name, Suffix (Jr. III, II) 1.5 x 2 Photo
(passport size)
Birth Date: / / Age : Religion : Preferred BS Marine Transportation
white background
(yyyy/mmm/dd)
Program: BS Marine Engineering

Birth Place: Height: ' '' Weight : Civil Status: Single Married
City/Province(ex. Calamba City, Laguna) (ft-inc) (kgs) Citizenship:
Mailing Address :
House No./Block/Lot/Street, Subd., Brgy. Municipality/City Province Zip Code Region

Home Tel. No. : Mobile No.: - Email Address:

FAMILY GUARDIAN Family members/kin enrolled in

FATHER MOTHER (if not living with parent/s)
BACKGROUND NTMA:
Full Name Name/Relation/Class
Occupation

Company (or state

nature of work)

Contact No. Year/s taken the NTMA Exam:

Email Address

EDUCATIONAL Municipality/City and Year Covered SENIOR HS DETAILS

School Name (Full Name) School Principal:
BACKGROUND Province (ex. 2018-2020)

Junior HS SHS Coordinator/Guidance Counselor:

(Grade 7-10)
Check () if : Public Private Science Science Class Contact No.:

Website:
Senior HS
FB Page:
(Grade 11-12) Check () if : Public Private Science Science Class
NOTE: Pre-Bac. Maritime
ACADEMIC STEM HUMSS ABM GAS SPORTS ARTS AND DESIGN
Grade 11 students Specialization
are not allowed to
take this exam Home Industrial
TECH. VOCATIONAL TVL-Maritime ICT Agri-Fishery Arts
Economics Arts
College Course:
College
____________________________
Awards/Honors/Citations/Extra-curricular Activities in High School: What social media
account/s do you often
use?
How did you know about NTMA? (Check ( ) your top 3 answers): Facebook
Visit of NTMA Team Facebook Friends Guidance Counselor/School Officials Twitter
NTMA Alumni Internet Search Parent / Relatives Career Fair Instagram
NTMA Website NTMA Cadet Posters Radio Others: __________
What do you know about NTMA? State briefly why you are interested to pursue maritime education/study in NTMA.

Reminders: Visit the NTMA website and official Facebook account to check the location of the Test Center where you prefer to take the Entrance Exam . Print your
application form in A4 size white bond paper. Proceed to the Test Center before 0700H and present the form together with a valid ID to the NTMA examiner. Bring at
least two pencils and a black pen. Applicants may only take the NTMAEE once in a year.

I hereby certify that all information supplied in this form are accurate and I authorize NTMA to verify all information provided herein. I am aware that said information is
confidential in nature and shall be used only for purposes of my application. I also give my consent freely and voluntarily to NTMA to use, share, and disclose the personal
data I provided on this form and in other electronic and recorded forms for purposes related to my application only. I fully understand that misrepresentation of information
provided in this form shall be grounds for non-admission and dismissal once admitted.

Signature over printed name

Revision: 17 as of 2019 August 08
Test Center (Province) Date (yyyy/mmm/dd) 2