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1933

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AFFIX
RECENT
PHOTO
1X1

PLEASE PRINT THIS IN A LONG SIZE BLUE PAPER

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STANINE:_____
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Office Use
(Do not fill up)

FRESHMEN ( ) TRANSFEREE (

NAME:____________________________________________________________________________________

Last Name


First Name

Middle Name

OLSAT

) CIT (

_________________________________

COURSE

SCHOOL LAST ATTENDED:__________________________________________________________________________________


SCHOOL ADDRESS:________________________________________________________________________________________ DATE ATTENDED:_________________
HOME ADDRESS:_________________________________________________________________________________________________________________________

# Street


Town/Barrio

City

Province

Postal Code
CDOC ADDRESS:_____________________________________________________________________________________ TELEPHONE NO.:(________)_____________
DATE OF BIRTH: ____________________________ CIVIL STATUS: ____________________________RELIGION:___________________________ AGE:______________
CITIZENSHIP:_______________________________ E-MAIL:_________________________________LANGUAGE/S SPOKEN:__________________SEX:______________

EDUCATIONAL BACKGROUND
List all grade schools, high schools and vocation/technical course attended

NAME OF SCHOOL

INCLUSIVE DATES/YEARS

DEGREE, HONORS,AWARD RECEIVED

PRIMARY:__________________________________________________

______________________________

___________________________________

ELEMENTARY:_______________________________________________

______________________________

___________________________________

SECONDARY:________________________________________________

______________________________

___________________________________

VOCATIONAL/TECHNICAL COURSE:______________________________

______________________________

___________________________________

FAMILY BACKGROUND
FATHERS NAME:__________________________________________________________ AGE:___________________

OCCUPATION:________________________

WORKING WITH:_________________________________________________________ COMPANYS ADDRESS:____________________________________________


MOTHERS NAME:________________________________________________________ AGE:___________________

OCCUPATION:________________________

WORKING WITH:_________________________________________________________ COMPANYS ADDRESS:____________________________________________


OR SPOUSE:_____________________________________________________________ AGE:___________________

OCCUPATION:________________________

GUARDIANS NAME:______________________________________________________ RELATIONSHIP:__________________________________________________


ADDRESS:______________________________________________________________ TEL. NO.:_______________________________________________________
NUMBER OF SIBLINGS IN THE FAMILY:__________________________

(name and their level of education from the eldest to the youngest)

AGE

NAME

LEVEL OF EDUCATION

1._______________________________________________________

___________

______________________________________________________

2._______________________________________________________

___________

______________________________________________________

3._______________________________________________________

___________

______________________________________________________

4._______________________________________________________

___________

______________________________________________________

5._______________________________________________________

___________

______________________________________________________

FOR TRANSFEREE ONLY


LIST ALL UNIVERSITIES AND/OR COLLEGES YOU HAVE ATTENDED AND INCLUSIVE DATES. PLEASE ARRANGE TO HAVE OFFICIAL TRANSCRIPT SENT TO THE UNIVERSITY
REGISTRARS OFFICE OF XU-ATENEO (Failure to disclose previous attendance at another institution could result in academic dismissal.)

SCHOOL
INCLUSIVE DATES

__________________________________________
_________________________________________
__________________________________________
_________________________________________
__________________________________________
_________________________________________

PLEASE ANSWER THE FOLLOWING QUESTIONS:


WHAT WERE THE IMPORTANT FACTORS IN YOUR DECISION TO APPLY TO XU-ATENEO?

1.________________________________________________________________________________________________________________

2.________________________________________________________________________________________________________________

3.________________________________________________________________________________________________________________

WHO WERE THE PEOPLE WHO INFLUENCED YOU MOST TO CHOOSE XU-ATENEO?

1._________________________________________________________________________________________________________________

2._________________________________________________________________________________________________________________

3._________________________________________________________________________________________________________________

YOUR INTEREST/HOBBIES :______________________________________________________________________________________________________


__________________________________________________________________________________________________________________

ATTESTATION
I hereby agree to abide by all the rules and regularities which apply to students of
XU-Ateneo and acknowledge that my right to remain at XU-Ateneo is subject to my
observance of them. The information in this applications complete and correct to the
best of my knowledge. I acknowledge that XU-Ateneo is required to abide by the Freedom of Information and Protection of Privacy legislation as it applies to universities.

_________________________________
Name & Signature of Father

________________________________
Name & Signature of Mother

________________________________
Student Signature

__________________________________
Name & Signature of Guardian
(if applicable)

________________________________
Date

COLLEGE COURSES
COLLEGE OF ARTS & SCIENCE
BACHELOR OF ARTS IN:
ECONOMICS, PHILOSOPHY, HISTORY, FILIPINO,SOCIOLOGY, INTERNATIONAL STUDIES,
ENGLISH LANGUAGE & LITERATURE STUDIES
BACHELOR OF SCIENCE IN:
BIOLOGY, CHEMISTRY, MATHEMATICS, MARINE BIOLOGY, PSYCHOLOGY
SCHOOL OF EDUCATION
BACHELOR OF ELEMENTARY EDUCATION Specializations in :
General Education, Special Education, Pre - School Education
BACHELOR OF SECONDARY EDUCATION MAJOR IN:
Biological Science, Mathematics, English, Filipino
PROFESSIONAL EDUCATION (for non-education graduates)
DIPLOMA OF SPECIAL EDUCATION TEACHING PROGRAM
SCHOOL OF BUSINESS AND MANAGEMENT
BACHELOR OF SCIENCE IN ACCOUNTANCY
BACHELOR OF SCIENCE IN BUSINESS ADMINISTRATION MAJOR IN:
Business Economics, Marketing Management, Financial Management
COLLEGE OF AGRICULTURE
BACHELOR OF SCIENCE IN:
AGRIBUSINESS, AGRICULTURAL ENGINEERING, FOOD TECHNOLOGY
BACHELOR OF SCIENCE IN AGRICULTURE MAJOR IN:
Crop Science, Animal Science, Agricultural Economics
BACHELOR OF SCIENCE IN DEVELOPMENT COMMUNICATION MAJOR IN:
Development Journalism, Educational Communication
COLLEGE OF ENGINEERING
BACHELOR OF SCIENCE IN:
CIVIL ENGINEERING, CHEMICAL ENGINEERING, ELECTRICAL ENGINEERING,
MECHANICAL ENGINEERING, ELECTRONICS ENGINEERING,INDUSTRIAL ENGINEERING
COLLEGE OF COMPUTER STUDIES
BACHELOR OF SCIENCE IN COMPUTER SCIENCE
BACHELOR OF SCIENCE INFORMATION SYSTEMS
COLLEGE OF NURSING
BACHELOR OF SCIENCE IN NURSING
CENTER FOR INTEGRATED TECHNOLOGIES - XU CIT
(3 YEAR TECHNOLOGY COURSES)
INDUSTRIAL ELECTRONICS TECHNOLOGY with Certificate in:
2nd Yr.: Consumer Electronics NC II, 3rd Yr.: Computer Hardware Servicing NC II
ELECTRONICS AND COMPUTER TECHNOLOGY with Certificate in:
2nd Yr.: Computer Hardware Servicing NC II, 3rd Yr.: Computer Programming NC IV
MECHANICAL ENGINEERING TECHNOLOGY Major in Metal Working with Certificate in:
1st Yr.: Machining NC 1, 2nd Yr.: Machining NC II, 3rd Yr.: Machining III
MECHANICAL ENGINEERING TECHNOLOGY Major in Automotive with Certificate in:
1st Yr.: Automotive Servicing NC II, 2nd Yr.: Automotive Servicing NC III,

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