UP Form No. 3.1 (Rev.

02012017) Do not write inside this box

University of the Philippines Diliman
OFFICE OF THE UNIVERSITY REGISTRAR Application fee P150 $30
Diliman, Quezon City 1101 (Non-refundable)
Philippines PMO/Cashier’s or Manager’s Check
O.R. No________________________
Staple 2 recent Date _____________ By __________
2”x2” photographs here EVALUATION
FOREIGN UNDERGRADUATE GWA __________ Units __________
ADMISSION APPLICATION Degree ________________________
Print and sign over printed name _______Semester/School Year_____ Referred to _____________________
at the back of the photographs _______________________________

NAME _________________________________________________________________________________________________________________
LAST FIRST MIDDLE MAIDEN

SEX ASSIGNED AT BIRTH Female Male CITIZENSHIP _____________________ RELIGION _______________________

CIVIL STATUS Single Married Others ____________________ If married, name of spouse _____________________________
E-MAIL ADDRESS /
DATE OF BIRTH _____________________ PLACE OF BIRTH ___________________CONTACT NOS. ______________________________

PERMANENT HOME ADDRESS _________________________________________________________________________________________

CURRENT ADDRESS ___________________________________________________________________________________________________
NAME OF FATHER________________________________________ NAME OF MOTHER ________________________________________

STATUS BEGINNING FRESHMAN SPECIAL STUDENT

(High school graduate with no college unit) (Will not earn credits for subjects taken in UP)

TRANSFER STUDENT CROSS-REGISTRANT

(Has taken college courses/graduated from another school) (Currently enrolled in a non-UP school; will earn
credits from UP)
NON-DEGREE STUDENT
(Will earn credits for subjects taken in UP) REJOINING
(UP graduate: will earn a second degree)

DEGREE PROGRAM/S APPLIED FOR SPECIFIC SUBJECTS APPLIED FOR

(list according to priority) (for non-degree,special or cross-registrant students only)

1. ____________________ 2. _________________________ _____________________ ___________________ ___________________

HIGH SCHOOL ATTENDED: ____________________________________________________________________________________________

Name of School Location Years Attended Date of Graduation
COLLEGE/S ATTENDED:
Name of School(s) Location Sem(s) & Year(s) Degree Pursued Date of Graduation
Attended
_______________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________
Are the grades for all subjects enrolled in college submitted with this application? Yes No

Are you currently enrolled in a school outside UP? Yes No

Were you ever subjected to academic or disciplinary action (i.e., probation, suspension, dismissal, expulsion) in the previous institutions that
you attended. Yes No If YES, explain by providing the dates and other details of the case: _______________________________
________________________________________________________________________________________________________________________
EXAMINATION/S TAKEN: IMMIGRATION STATUS:
GCE Yr. Taken ______________ Passport No. ______________ Date of Issue _____________ Valid Until ____________________
Result/Score: O level ________ A Level ____________ Type of Visa ______________ Date of Issue _____________ Valid Until ____________________
ACR/ICR No. _____________ Date Of Issue _____________ Place ________________________
SAT Yr. Taken ________________ For applicants from non-English speaking countries:
Result/Score: Evidence-Based Reading & Writing______ Date TOEFL/IELTS taken ___________________ Score _______________________
Math______________________________ Date TOEFL/IELTS score sent to UP __________________________________________

I hereby affirm that all information supplied herein is complete and accurate. Withholding or giving false information will
make me ineligible for admission or be subject to dismissal. If admitted, I agree to abide by the policies, rules and regulations of the
University of the Philippines.
_____________________________________ _________________________________
Signature Date
I have read the University of the Philippines' Privacy Notice for Students.

I grant my consent to and recognize the authority of the University of the Philippines to process my personal
and sensitive personal information, pursuant to the abovementioned Privacy Notice and applicable laws in
connection with my application to shift/transfer/ be admitted as a student of UP DILIMAN.

I likewise consent to and recognize UP's authority to post online and/or in UP bulletin boards at its option my
name and program in the event I qualify for admission in order for the University to comply with its Charter and
uphold the principle of transparency in the admissions process.

_______________________________________ _______________________________________

Signature of the student over printed name Signature of Parent/Guardian over printed name
if applicant is a minor

Date: _____________________________________ Date:_______________________________________