UPLB Form No. 3 (Rev.

4/2006)

UNIVERSITY OF THE PHILIPPINES LOS BAÑOS

College, Laguna, Philippines
Do not write inside this box.

APPLICATION FEE
OFFICE OF THE UNIVERSITY REGISTRAR Filipino - P 100.00 [ ]
Foreigner - $ 20.00 [ ]
UNDERGRADUATE ADMISSION APPLICATION C.R. No________Date_______
Date________________By__________
EVALUATION
NAME________________________________________________________________ No. of units___________Wtd. Ave.____
Last First Middle Degree Holder_____________________
SEX ( ) Female ( ) Male CITIZENSHIP ___________________ Referred to______________By_______
Date___________________
CIVIL STATUS: ( ) Single ( ) Married [ ] Qualified [ ] Not Qualified

If married, name of spouse____________________________________________________________________

DATE OF BIRTH ______________________________PLACE OF BIRTH ______________________________

PERMANENT HOME ADDRESS _______________________________________________________________

CURRENT ADDRESS _________________________________________________________________________
TELEPHONE NO. ______________________________ E-MAIL ADDRESS : ________________________

Check appropriate blank below:

APPLYING FOR ADMISSION AS: FOR ADMISSION STARTING:
[ ] Beginning Freshman (high school graduate [ ] First Semester, _________
with no college credit) [ ] Second Semester, _______
[ ] Transfer Student (with at least 33 [ ] Summer, _______
academic units from another college)
[ ] Non-Degree Student (will earn credits Specific Subjects Applied For:
for subjects taken at UPLB) (For non-degree and special students only)
[ ] Special Student (will not earn any _____________________________
credit for subjects taken at UPLB) _____________________________
[ ] Old Returning _____________________________
[ ] Other, Please specify___________
Course Program Applied for and College:
[ ] College of Agriculture [ ] College of Economics and Management
[ ] B.S. Agriculture [ ] B.S. Agribusiness Management
[ ] B.S. Food Technology [ ] B.S. Agricultural Economics
[ ] B.S. Economics
[ ] College of Arts and Sciences
[ ] B.A. Communication Arts [ ] College of Engineering and Agro-Industrial
[ ] B.A. Philosophy Technology
[ ] B.A. Sociology [ ] B.S. Agricultural Engineering
[ ] B.S. Applied Mathematics [ ] B.S. Chemical Engineering
[ ] B.S. Applied Physics [ ] B.S. Civil Engineering
[ ] B.S. Biology [ ] B.S. Electrical Engineering
[ ] B.S. Chemistry [ ] B.S. Industrial Engineering
[ ] B.S. Computer Science
[ ] B.S. Mathematics [ ] College of Forestry and Natural Resources
[ ] B.S. Mathematics and Science Teaching [ ] B.S. Forestry
[ ] B.S. Statistics

[ ] CA-CAS Joint Program [ ] College of Human Ecology

[ ] B.S. Agricultural Chemistry [ ] B.S. Human Ecology
[ ] B.S. Nutrition
[ ] College of Development Communication [ ] College of Veterinary Medicine
[ ] B.S. Development Communication [ ] Doctor of Veterinary Medicine*
*passing the National Veterinary Admission Test (NVAT) is
a requisite for admission to the Four-Year Professional
Veterinary Medicine curriculum.
If you are admitted, will it be your first enrolment in UP?
[ ] Yes [ ] No If no, answer the following:
UP College(s) Attended Semester(s) & Schoolyear(s) Attended Course Classification
 (regular, non-degree or special)
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________

FATHER [ ] Living MOTHER [ ] Living GUARDIAN/SPOUSE

[ ] Deceased [ ] Deceased
Name ____________________________ ________________________________ _____________________________
Address __________________________ ________________________________ _____________________________
Telephone No.______________________ ________________________________ _____________________________
e-mail Address _____________________ ________________________________ _____________________________
Business Address __________________ ________________________________ _____________________________
Occupation _______________________ ________________________________ ____________________________
FINANCIAL SUPPORT:

[ ] Parents [ ] Self [ ] Loan [ ] Scholarship [ ] Other, Specify:____________________

PERSON TO BE NOTIFIED IN CASE OF EMERGENCY:

Name ________________________________________________ Relationship____________________________________

Address ______________________________________________ Telephone._____________________________________

List in chronological order all schools* attended starting from secondary school:

Name of School Location Dates Diploma or Honors

Attended Degree Received
__________________________ _________________ _____________ _________________ _____________
__________________________ _________________ _____________ _________________ _____________
__________________________ _________________ _____________ _________________ _____________
* Transcript of records or true copy of grades duly certified by appropriate school authorities in all institutions attended should be sent to
the Office of the University Registrar, UPLB, College, Laguna, Philippines. This application will not be considered unless these
records are received.

Are you presently enrolled? [ ] Yes [ ] No If yes, in what school are you enrolled?_______________________________

Have you ever been subject to academic or disciplinary action (i.e. probation, suspension, dismissal) from any institution attended?
[ ] Yes [ ] No If yes, please explain giving the dates and other details: _______________________________________
____________________________________________________________________________________

Non-Filipino students: Immigration status __________________________ACR/ICR No. __________________________

Date Issued_________________________________ Where Issued___________________________

For applicants from non-English speaking countries: Submit your TOEFL score along with your academic records as part of your
application credentials.

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
Attach a recent 2" x 2" regulations of the University of the Philippines Los Baños.
photograph here

Please sign photograph

at the back _______________________
Signature

_______________________
Date

IMPORTANT NOTICE :

Evaluation of application for admission will be made upon submission of all official copy of grades/examination certificates or
transcript of all collegiate courses enrolled in.