KUMUSTAHAN / COUNSELING / FACULTY CONSULTATION REGISTRATION FORM
Data Privacy Act:

In compliance with R.A 10173 (Data Privacy Act of 2012), data acquired through this form are only collected, processed, stored, and disposed by duly authorized staff, exclusively for the lawful purposes related to Online Counseling. NQCI assures that it will protect the privacy and confidentiality of the information provided with utmost diligence.
Email *
How we may help you? *
Name of Student (First Name, Middle Initial, Surname) (ex. Juan B. Dela Cruz) *
Year and Section *
Course *
Student ID Number *
Age *
Assigned sex at Birth *
Mobile Number *
Facebook Account *
Preferred Platform for Counseling and Kumustahan *
For Faculty Consultation, kindly input the name of the Faculty Member and concern/s
By clicking "Agree," you agree to the collection, processing, storage, and disposal of your data. *
A copy of your responses will be emailed to the address you provided.
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