Application Fee: University of the Staple 2 recent 2” x 2” P150 $20 OFFICE OF THE UNIVERSITY REGISTRAR photographs Non-refundable Padre Faura Street, , Manila O.R. No. ______FOREIGN UNDERGRADUATE EVALUATION ADMISSION APPLICATION Please sign GWA______Semester/AY______Units_____ photographs Degree______at the back Referred to______U.P. Form No. 3.1 (Rev. 11-26-2014)

______SURNAME/LAST NAME FIRST NAME MIDDLE NAME

Date of Birth (mm/dd/yy):______Civil Status: ______

Male Female Citizenship: ______Permanent Address: Present Address:

Telephone/Cellphone No. (Area Code)+ Tel. No. ______Email Address:______

NAME OF FATHER______NAME OF MOTHER______

STATUS: ∏ BEGINNING FRESHMAN (High school graduate with no college unit)

∏ TRANSFER STUDENT (Has taken college courses/graduates from other schools)

DEGREE PROGRAMS APPLIED FOR (list according to priority preferably Bachelor of Arts courses)

1.______2.______HIGH SCHOOL ATTENDED: ______Name of School Location Years attended Date of graduation

COLLEGE/S ATTENDED: Name of School Location Sem(s) & Year(s) Degree Pursued Date of Graduation Attended ______Are all grades for all collegiate subjects enrolled already submitted with this application? ∏Yes ∏No Are you still enrolled in a school outside UP? ∏Yes ∏No 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 by giving the dates and other details: ______

Examination Taken: Year Taken ______IMMIGRATION STATUS: GCE Result/Score: O Level______A Level ______Passport No._____ Date of issue ______Valid until_____ Type of Visa _____ Date of issue ______Valid until_____ SAT Result/Score: Verbal ______Mathematical ______ACR/ICR No._____ Date of issue ______Place ______Year Taken ______For applicants from non-English speaking countries: Date of TOEFL taken ______Score ______Date of TOEFL score sent to UP Manila ______

I hereby affirm that all information supplied herein are complete and accurate and that all pertinent documents are official, true and correct. 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 Manila.

______Signature Date