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Application Form-B

Dear Applicants: Data generated from this form will be used for research purposes and will not be listed individually in any report. Rest assured your responses will be kept completely confidential. Moreover, your answers will not in any way affect the results of your application to DLS-CSB

NAM E
Surname F ir s t N a m e Middle Name

PERMANENT ADDRESS (No. - St. - District/Brgy. - City/Province:

MARKING INSTRUCTIONS 1. Use a pencil preferably with #2 lead. 2. Print the letters and numbers in the required blank spaces ad boxes. 3. Completely fill / shade the bubble. 4. Completely erase any error or stray marks. TE R M OF APPLICATION S CHOOL YEAR
CORR EC T MARK: I N C O R R E C T M A R K S:

CIVIL STATUS

Single Married Others


ZIP CODE AD D RES S

D O NO T F I L L THIS PORTION
CASE NO.
0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 0 1 2 3 4 5 6 7 8 9

APPLICATION TYPE

Freshman Transferee CDP 2nd Undergraduate Degree


D ATE OF BIRTH
M M D D Y Y Y Y

1st term 2nd term 3rd term

0 1 2 3 4

0 1 2 3 4 5 6 7 8 9

0 1 2 3 4 5 6 7 8 9

0 1 2 3 4 5 6 7 8 9

0 1 2 3 4 5 6 7 8 9

0 1 2 3 4 5 6 7 8 9

0 1 2 3 4 5 6 7 8 9

0 1 2 3 4 5 6 7 8 9

0 1 2 3 4 5 6 7 8 9

0 1 2 3 4 5 6 7 8 9

0 1 2 3 4 5 6 7 8 9

0 1 2 3 4 5 6 7 8 9

GE N D E R

5 6

0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9

0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9

Male Female

7 8 9

NATIONALITY

R E L I G I ON

4 5 6 7 8 9

DO NOT FILL THIS PORTION


DEGREE CODE
1st 2nd 3rd

Filipino Non-Filipino (pls. specify)

Catholic Non-Catholic (pls. specify)


0 1 2

0 1 2 3 4 5 6 7 8 9

0 1 2 3 4 5 6 7 8 9

0 1 2 3 4 5 6 7 8 9

0 1 2 3 4 5 6 7 8 9

0 1 2 3 4 5 6 7 8 9

0 1 2 3 4 5 6 7 8 9

0 1 2 3 4 5 6 7 8 9

0 1 2 3 4 5 6 7 8 9

DLS-CSB DEGREE PROGRAMS

3 4 5 6 7 8 9

1st Choice 2nd Choice 3rd Choice

TYPE OF HIGH SCHOOL YOU ATTENDED

ANNUAL INCOME OF PARENTS

WHO AMONG YOUR FAMILY ARE ALUMNI OF ANY LA SALLE S CHOOL? (Sh ade all that applies)

Science High School National High School Barangay High School Private Sectarian Private Non-sectarian Others (pls. specify)

Above Php 1,000,000.00 Php 750,001.00 - Php 1,000,000.00 Php 500,001.00 - Php 750,000.00 Php 250,001.00 - Php 500,000.00 Php 250,000.00 and below
EDUCATIONAL ATTAINMENT OF MOTHER

Grandparents Father Mother Siblings None


EDUCATIONAL ATTAINMENT OF FATHER

WHO AMONG YOUR PARENTS ARE WORKING ABROAD?

Mother only Father only

Both None

Elementary High School Vocational Course College Post - College

Elementary High School Vocational Course College Post - College

CUR RENT EMPLOYME NT OF FATHER (Choose only one)

CU RRE NT EMPLOYMENT OF MOT HER (Choose only one)

Government Self-Employed Private None/Deceased If employed, select the field of occupation: Academic/Education/Training Accounting/Finance Administrative/Human Resources Architecture/Interior Design/Building & Construction Arts/Media/Communication Computer/Information Technology Diplomatic Affairs Engineering (e.g. Industrial Design, Industrial Engineering Healthcare Hotel/Restaurant Legal Services Manufacturing/Production Sales/Marketing Sciences (e.g. Aviation, Geology, Agriculture) Services (e.g. Customer service, Personal Care) Other (pls. specify)

Government Self-Employed Private None/Deceased If employed, select the field of occupation: Academic/Education/Training Accounting/Finance Administrative/Human Resources Architecture/Interior Design/Building & Construction Arts/Media/Communication Computer/Information Technology Diplomatic Affairs Engineering (e.g. Industrial Design, Industrial Engineering Healthcare Hotel/Restaurant Legal Services Manufacturing/Production Sales/Marketing Sciences (e.g. Aviation, Geology, Agriculture) Services (e.g. Customer service, Personal Care) Other (pls. specify)

PLEASE STATE YOUR REASON(S) FOR APPLYING TO DLS -CSB (Shade all that applies)

Prestige of DLS-CSB Degree Program(s) Offered Recommended by Principal Recommended by Teacher

Recommended by Counselor Recommended by Grandparents / Relatives Recommended by Parents

Recommended by Siblings Recommended by Friends Others (pls. specify)

DO NOT DETACH / DO NOT TEAR

Name: Surname, First Name, Middle Name

DO NOT FILL THIS PORTION


CASE NUMBER

HOW DID YOU LEARN ABOUT DLS-CSB? (Sha de all that applies)

Grandparents Parents Siblings Friends / Classmates High School Teacher Homeroom Adviser

School Counselors Print Ads News Articles Career Talks / Fairs In-campus Tours DLS-CSB Website

Internet: On-line Ads Social Networking Sites Others (pls. specify)

WHAT ARE THE SOURCES OF INFORMATION YOU CONSULTED IN LOOKING FOR A PROSPECTIVE COLLEGE OR UNIVERS ITY YOU INTEND TO ENROLL IN? (Sh ade all th at applies)

College Prospectus School Website College / University visits Faculty of College / University Media (Press reports, TV ads, radio)

Students Enrolled in Colleges / Universities Friends High School Administrators High School Staff / Guidance

Alumni of the College / University College/University Fairs Career Guidance Others (pls. specify)

FACTORS IN YOUR DECISION TO ENROLL IN A PARTICULAR COLLEGE / UNIVERSITY

VERY IMPORTANT V.I.

MODERATELY IMPORTANT M.I.


VI MI SI NI

SLIGHTLY IMPORTANT S.I.

NOT IMPORTANT N.I.


VI MI SI NI

A. Attractiveness of location B. Attractiveness of campus C. Close to residence location D. Close to employment location E. Transportation accessibility F. Family income G. Tuition fee H. Availability of scholarship I. School reputation J. Library facilities K. Sports facilities L. Computer facilities

M. Flexibility of course N. Shorter time to finish course O. Diversity of course offerings P. Quality of teaching Q. Social atmosphere R. Parent's alma mater S. Parent's recommendation T. Friend's alma mater U. Friend's recommendation V. Recommended by High School Guidance Counselor / Administrator W. Others (pls. specify)

S C H O LA R S H I P

Are you applying for scholarship?

Yes

No

WHAT THREE COURSES ARE YOU MOST INTERESTED IN? (REGARDLESS OF ANY COLLEGE / UNIVERSITY) Do not abbreviate. Write complete name of course. (e.g. BS BA in Human Resource Management) 1 s t Cho i c e 2nd Choice 3rd Ch oice

WHAT ARE THE TOP THREE UNIVERSITIES / COLLEGES WOULD YOU MOS T LIKELY ENROLL IN? Do not abbreviate. Write complete name of school. (e.g. De La Salle-College of S t. Benilde, Manila) Un iversity / College Name To p 1 To p 2 To p 3 Address/Branch/Campus

WHO WILL FINANCE YOUR COLLEGE SCHOOLING? (Shade all that applies)

Parents

Siblings

Relatives

Spouse

Self YES YES

Scholarship NO NO

DID YOU APPLY TO DLSU-MANILA? For Non-Metro Manila residents only: DO YOU HAVE RELATIVES IN MANILA?
DO NOT FILL IN THIS SECTION

1st Choice
0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9

2n d C h o i ce
0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9

3rd Choice
0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9

Top 1
0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9

Top 2
0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9

Top 3
0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9