Use the form below to submit an application for PRC licensure examination. Enter the required information in the appropriate fields. All fields marked with * are required.

Examination Details
Date filed *
Name of examination *  
Date of examination *  
Place of examination *  
Examination type *  
Number of times taken * (0 if not applicable)   

FOR LET APPLICANTS ONLY
Level
Major (Sec. Teachers)

FOR MARINE DECK/ENGINE APPLICANTS ONLY
Rank

Applicant's Personal Information
Last name *  
First name *     Name suffix
Middle name *  
Mother's maiden name (for married female)
Date of birth *  
Place of birth
 
Gender *  
Civil status *  
Citizenship *  
Legal status * Have you ever been convicted by final judgement by any court of justice/military tribunal or administrative body?  
Permanent mailing address (No./Street/Barangay) *  
City/Municipality *
 
Spouse's full name
Spouse's citizenship
Father's full name
Father's citizenship
Mother's full maiden name
Mother's citizenship *  
Cellphone no.
Telephone no.
Email address  
Community Tax Cert. (Cedula) *  
Place issued *  
Date issued *  

School Information
Name of school graduated *  
School address *
School code *
Degree/course *  
Date of graduation * Select date  

Review Center Information
Name of review center

Previous Examinations Taken
Name of examination
Place of examination
Date taken  
Rating  
Result of examination

IMPORTANT: Please review all information carefully prior to the submission of your application.