UP Form No. 3A (Rev.

March 2019) EVALUATION

GWA _____________ Units ____________
University of the Philippines Diliman Degree _____________________________
OFFICE OF THE UNIVERSITY REGISTRAR Referred to __________________________
Diliman, Quezon City 1101 Deficiencies _________________________
___________________________________
Philippines
`
ADMISSION APPLICATION SUBJECT TO AVAILABILITY OF SLOTS
Staple 2 recent Do not write inside this box
2”x2” photographs
Application fee (Non-refundable)
here
P100 (for cross-registrants from a non-
Print and sign over printed UP home unit, non-degree and Special
name UNDERGRADUATE Students)
at the back of the photographs (NEW FRESHMEN –Automatic Admission O.R. No.___________________________
and NON-REGULAR STUDENTS) Date ________________ By __________
_______Semester/School Year_________
P100 (c/o Higher Education Subsidy)
Reference No ______________________
Less Higher Education Subsidy: P100
Total Amount due: P0
Date ________________ By __________

NAME
_____________________________________________________________________________________________________
LAST FIRST MIDDLE MAIDEN

SEX ASSIGNED AT BIRTH Female Male Others__________ 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 (Automatic Admission) SPECIAL STUDENT WITHOUT CREDIT
(High school graduate with no college unit) (Will not earn credits for subjects taken in UP)
CROSS-REGISTRANT NON-DEGREE STUDENT
(Currently enrolled in a non-UP school; will earn credits from UP) (Will earn credits for subjects taken in UP)

DEGREE PROGRAM/S APPLIED FOR SPECIFIC SUBJECTS APPLIED FOR

(list according to priority- for automatic admission only) (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) Attended Degree Pursued Date of Graduation

_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________

Have you ever been subjected 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
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:______________________________________

ANNEX "D" TO BE INSERTED IN APPLICATION FORMS FOR STUDENTS SEEKING ADMISSION TO UP (EXCEPT
UPCAT APPLICANTS) E.G. VAAS, CERTIFICATE/ GRADUATE PROGRAMS AS WELL AS SHIFTEESITRANSFEREES