Create Student Account

Step 1 Account Credentials

Full Name *

Username *

Institutional Email *

Mobile Contact *

Password *

Confirm Password *

Step 2 Academic & Sport Discipline

Student ID # *

Primary Sport *

Department *

Course / Program *

Year Level *

Block / Section *

Date of Birth *

Gender *

Step 3 Emergency Contact & MASTS Eligibility Details

Contact Person & Relationship *

Contact Phone Number *

MASTS Eligibility Details (used for MASTS Form 1, 2 & 3)

Height (cm) *

Weight (kg) *

Blood Type *

Home Address *

Allergies *

Medications (if any)

Parent / Guardian Name *

Parent / Guardian Contact # *

Photo for MASTS Form 2 (JPG or PNG, ID style) *

North Eastern Mindanao State University • Cantilan Campus
Protected under RA 10173 (Data Privacy Act)