LET Application Form
PRC Form No. 001
(Revised September 2010)
NOT FOR SALE
Republic of the Philippines
REPRODUCTION
IS ALLOWED
PROFESSIONAL REGULATION COMMISSION
Application No.
Manila
PRC Central Office : APPLICATION DIVISION P. Paredes St., Sampaloc 1008 Manila, Philippines
Website : www.prc.gov.ph Tel. No.: (63-2) - 314-00-27
Paste here your recent passport size picture with COMPLETE
Name Tag in plain white background APPLICATION FORM
First Timer
Repeater
Conditioned
Absent
Name of Examination
Date of Examination
Place of Examination
Date (mm/dd/yy)
Scanned/Photocopied picture not accepted
NOTICE : This application must be filled out in INK and in the applicant’s handwriting. All supporting documents shall become part of the records of the Commiss ion. All applic ations must be f iled PERSONALLY by the applicant.
PART I -PERSONAL INFORMATION
MIDDLE NAME
GIVEN NAME/S
SURNAME
Maiden Surname (for married female only)
Permanent Mailing Address (House no., Street, Village/Subd., Brgy., Town, Prov./City)
Gender
Male
Civil Status
Single
Contact Numbers (Landline & Mobile)
Citizenship
Female
Filipino
(Town/City, Prov)
E-mail Address
__ __ __ __
Others __ __ __ __
RURBAN Code (Town/City, Prov)
Place of Birth (City/Town,Prov.)
Date of Birth (mm/dd/yy)
Married
RURBAN Code
Zip Code
Widow/er
Father’s Name & Citizenship
Spouse’s Name & Citizenship
Mother’s Name & Citizenship
HAVE YOU EVER BEEN CHARGED AND CONVICTED BY FINAL JUDGEMENT BY ANY COURT OF JUSTICE/MILITARY TRIBUNAL OR
ADMINISTRATIVE BODY?
No
Yes
(If yes, attach hereto a copy of the decision)
PART II -EDUCATIONAL INFORMATION
PRC School Code
Address/Location of School
Name of School
Degree/Course Obtained
Other Higher Educational Attainment
PRC Board Code
Date Graduated (mm/dd/yy)
PRC COURSE Code
Date Graduated
Address/Location of School
Name of School
(mm/dd/yy)
PRC
(Revised September 2010)
NOT FOR SALE
Republic of the Philippines
REPRODUCTION
IS ALLOWED
PROFESSIONAL REGULATION COMMISSION
Application No.
Manila
PRC Central Office : APPLICATION DIVISION P. Paredes St., Sampaloc 1008 Manila, Philippines
Website : www.prc.gov.ph Tel. No.: (63-2) - 314-00-27
Paste here your recent passport size picture with COMPLETE
Name Tag in plain white background APPLICATION FORM
First Timer
Repeater
Conditioned
Absent
Name of Examination
Date of Examination
Place of Examination
Date (mm/dd/yy)
Scanned/Photocopied picture not accepted
NOTICE : This application must be filled out in INK and in the applicant’s handwriting. All supporting documents shall become part of the records of the Commiss ion. All applic ations must be f iled PERSONALLY by the applicant.
PART I -PERSONAL INFORMATION
MIDDLE NAME
GIVEN NAME/S
SURNAME
Maiden Surname (for married female only)
Permanent Mailing Address (House no., Street, Village/Subd., Brgy., Town, Prov./City)
Gender
Male
Civil Status
Single
Contact Numbers (Landline & Mobile)
Citizenship
Female
Filipino
(Town/City, Prov)
E-mail Address
__ __ __ __
Others __ __ __ __
RURBAN Code (Town/City, Prov)
Place of Birth (City/Town,Prov.)
Date of Birth (mm/dd/yy)
Married
RURBAN Code
Zip Code
Widow/er
Father’s Name & Citizenship
Spouse’s Name & Citizenship
Mother’s Name & Citizenship
HAVE YOU EVER BEEN CHARGED AND CONVICTED BY FINAL JUDGEMENT BY ANY COURT OF JUSTICE/MILITARY TRIBUNAL OR
ADMINISTRATIVE BODY?
No
Yes
(If yes, attach hereto a copy of the decision)
PART II -EDUCATIONAL INFORMATION
PRC School Code
Address/Location of School
Name of School
Degree/Course Obtained
Other Higher Educational Attainment
PRC Board Code
Date Graduated (mm/dd/yy)
PRC COURSE Code
Date Graduated
Address/Location of School
Name of School
(mm/dd/yy)
PRC