UP Form No. 3A (Rev.
07-07)
Do not write inside this box
University of the Philippines Diliman
OFFICE OF THE UNIVERSITY REGISTRAR
Diliman, Quezon City 1101
Philippines
Staple 2 recent 2 x 2
photographs here.
Application fee
(Non-refundable)
P150
$20
O.R. No________________________
Date _____________ By __________
EVALUATION
GWA __________ Units __________
Deficiencies_____________________
_________ _____________________
UNDERGRADUATE
ADMISSION APPLICATION
Please sign photographs
at the back.
P100
(NEW FRESHMEN Automatic Admission
AND NON-REGULAR STUDENTS)
__________SEM/SCH. YR __________
NAME ________________________________________________________________________________________________________
LAST
SEX
Female
CIVIL STATUS
FIRST
Male
Single
MIDDLE
MAIDEN
CITIZENSHIP ________________________ RELIGION ______________________________
Married
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 (Automatic Admission)
(High school graduate with no college unit)
CROSS-REGISTRANT
(Currently enrolled in a non-UP school;will earn
credits from UP)
SPECIAL STUDENT WITHOUT CREDIT
(Will not earn credits for subjects taken in UP)
NON-DEGREE STUDENT
(Will earn credits for subjects taken in UP)
DEGREE PROGRAM/S APPLIED FOR
(list according to priority- for automatic admission only)
SPECIFIC SUBJECTS APPLIED FOR:
(for non-degree,special, or cross-registrant students only)
1. ____________________
2. _________________________
________________
________________
_________________
3. ____________________
4. _________________________
________________ ________________
_________________
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
_______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
Have you ever been subject to academic or disciplinary action (i.e. probation, suspension, dismissal, expulsion) from any institution attended?
Yes
No
If yes, explain giving the dates and other details: _____________________________________________
I hereby affirm that all information supplied herein is complete and accurate. Withholding or giving false
information will make me ineligible for admission or subject to dismissal. If admitted, I agree to abide by the policies,
rules and regulations of the University of the Philippines.
_______________________
Signature
____________________
Date
