Form No.

UG-11

STATEMENT OF UNDERTAKING
Please print all entries

Last Name
Given Name
Middle Name
Academic Plan
(Degree Code)

Academic Year/
Term

I, together with my Parent On-Record, understand and agree that, as a probationary student,
the following special terms and conditions of my enrollment apply, over and above regular
academic and student policies.
1. A Cumulative Grade Point Average (CGPA) of 1.200 or better must be earned at the end of

the first academic year or at the end of the first three (3) terms.
2. No academic or non-academic course may be dropped in the first two (2) terms.
3. A Leave of Absence (LOA) cannot be filed in the first term. Any LOA on subsequent terms

within the first academic year or the first three (3) trimesters will extend the probationary
period by the number of terms the student is on leave; and
4. Non-compliance with any of the above conditions would result to my ineligibility to re-enroll

for succeeding terms.

It is understood that after compliance with all of the above conditions, the student shall be
released from this probationary status at the end of the first academic year or the first three (3)
trimesters, unless extended. After the probationary period, regular academic and student
policies shall apply.

Student

Parent On-Record

Signature over Printed Name

Signature over Printed Name

Date

Date

**Note: This form must be accomplished in duplicate.

2401 Taft Avenue, 1004 Manila, Philippines | Direct Line: (632) 523-4230 | Trunk Line: (632) 524-4611 loc. 166
admissions@dlsu.edu.ph | www.dlsu.edu.ph/admissions