11/13/2019 Pamantasan ng Lungsod ng Maynila - Freshmen Admission

Requirements for Online Submission:

✓ Scanned copy (PDF/image format) of the following documents:
Grade 12 school ID
PSA Birth Certi cate
Grade 7-11 Form 138 (Report Card)/Form 137
For Alternative Learning System (ALS) completers and Accreditation &
Equivalency (A&E) Passers: Certi cate of Completion
For Manila Residents, any of the following:
Applicant's parent - Proof of Billing (i.e. electricity, water, telephone, etc.)
Parent's Income Tax Return with address
Voter’s Registration Form of Student/Parent
 1.5X1.5 ID picture (colored with white background)

Reminders:
✓ Applicants with de ciency in the requirements will not be processed.
✓ On your examination day, present the exam permit to the examiner/proctor
together with the signed Data Privacy Act Consent Form.
✓ No permit, no exam.

Application Form

Do not abbreviate vital information.

Information in * are required.
If you don't have a middle name, type an underscore (_).

Personal Information

Last Name *

Pelayo

First Name *

Criselle Ann

Middle Name *

Saban

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Name Extension Name Extension

Maiden Name (if married)

Birth Date *

05/19/2002

Birth Place *

Quezon City

Contact No. *

0946927470

Valid E-mail Address *

criselleann.pelayo@gmail.com

Sex *

Female

Disability

Mailing/Permanent Address

You may go to this website (https://www.phlpost.gov.ph/zip-code-search.php) to find your zip code.

Region - choose : A) NCR, B) CALABARZON, C) CENTRAL LUZON, D) OTHERS
Province - NCR (1st District - City of Manila)
NCR (2nd District - Mandaluyong, Marikina, Pasig, San Juan, Quezon City)
NCR (3rd District - Caloocan, Malabon, Navotas, Valenzuela)
NCR (4th District - Las Piñas, Makati, Muntilupa, Parañaque, Pasay, Pateros, Taguig)

House No./St./Vill./Subd./Compound *

Phase 2 Block 8 Lot 301 Green Breeze

Region * REGION IV-A (CALABARZON)

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Province * RIZAL

City/Municipality * RODRIGUEZ (MONTALBAN)

Barangay * San Isidro

Zip Code *

1860

School Information

Learner's Reference No. (LRN) *

136542070745
LRN is indicated in the student’s Permanent Record, (Form 137), Report Card (Form 138), ALS Certificate

School/Senior High School Attended *

St. Matthew College

School Address *

Phase 2 Block 8 Lot 301 Green Breeze

Academic Strand/ALS * STEM

General Weighted Average

Grade 7 *

91.08

Grade 8 *

90.50

Grade 9 *

91

Grade 10 *

92

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Grade 11 *

92

Family

FATHER

Last Name *

Pelayo

First Name *

Jessie

Middle Name *

Barrientos

Address *

Phase 2 Block 8 Lot 301 Green Breeze

Contact No. *

09469569623

Occupation *

Driver

MOTHER (Maiden Name)

Last Name *

Pelayo

First Name *

Analeza

Middle Name *

Saban

Address *

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Phase 2 Block 8 Lot 301 Green Breeze

Contact No. *

Occupation *

Annual Family Income *

124170

Course Preference

First Choice *

Bachelor of Science in Physical Therapy

Second Choice *

Bachelor of Science in Business Administration Major in Financial Management

Third Choice *

Bachelor of Arts in Communication

Requirements

Note: For uploading multiple files, hold 'CTRL' while selecting files.
The total size of files to be uploaded must not exceed 15 MB (megabytes).

1.5 x 1.5 ID Picture (Image Format) *

Choose File Untitled-1.jpg

Grade 12 School ID (PDF/Image Format) *

Choose Files New Doc 2019-11-13 20.33.50_1.jpg

PSA Birth Certificate (PDF) *

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Choose Files PDFPSA.pdf

Grade 7-11 Form 138 (Report Card)/Form 137 (PDF) *

Choose any of the two:

Form 137: Transcript of Records from Grades 7 to 10 & Form 138 for Grade 11
Form 138 from Grades 7 to 11

Choose Files GRADES 7-11.pdf

Certi cation

I hereby certify that the information provided above is true and correct based on my personal
knowledge and available records. Providing false and inaccurate information may be ground
for disquali cation from the University.

I Submit
By clicking the 'Submit Application' button, you have fully understood and agreed to the
Data Privacy Act Consent (Data_Privacy_Consent_Form.pdf).

Submit Application
For any inquiry, email at registrar@plm.edu.ph

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