(As stated in Birth Certificate. Please PRINT or TYPE.

STUDENT APPLICANT Surname First Name Middle Name Nickname

ADMISSIONS CENTER
2544 Taft Ave., Manila, Philippines 1004 Tel Nos.: 526-7441 to 47 loc. 126, 220 & 221 Telefax: 524-8233 Email: [email protected] Website: www.dls-csb.edu.ph/admissions Office Hours: Mon.-Fri. 8:00am-12:00nn & 1:30pm-5:00pm /Sat. 8:00am-12:00nn

Gender

Male

Female

(Assigned ID Number once applicant is enrolled)

Application Form-A
Submit this form together with all admission requirements indicated in the College Prospectus for your entrance examination permit and schedule. Only complete applications will be processed. PRINT OR TYPE YOUR ANSWERS. Application is made as a Freshman student CDP student Transfer student For the 1st Trimester 2nd Trimester 2nd undergraduate degree student Others, pls. specify: ____________________________ 3rd Trimester School Year _____ to _____

2X2 Colored Picture

(Attach 3 copies)

PERSONAL DATA
Mailing Address (WRITE LEGIBLY. Mailed application status letters are sent to this address.) Permanent Address Date of Birth (MM/DD/YY) Age Height Place of Birth Weight Citizenship Email Address Religion Telephone Number Civil Status Zip Code Zip Code Cellphone Number If married, name of spouse

ENTRY INFORMATION (Indicate the degree program you plan to enroll in at DLS-CSB)
DEGREE PROGRAM
1ST CHOICE 2ND CHOICE 3RD CHOICE

DEGREE CODE

Are you applying for a scholarship? SOFA SDA Grant

DO NOT FILL THIS AREA A

NO YES, which scholarship? BASAP BHS KBS

B CGPA C
HS GPA

Honors
D
BEE HS MATH HS SCIENCE

Others, pls. specify: ___________

CASE NO.
HS MKB CND RCMF RANK

PROGRAM

HS COM ARTS

DEFICIENCIES:
AF PIC BC SSR RFP RFC RFP-P RFC-P PEPT CF137 CGMC F138 ACR Passport GAF OTHERS:

REMARKS:

EDUCATIONAL BACKGROUND (Include all schools attended and/or enrolled in; provide extra sheets if necessary)
GRADE SCHOOL Grade(s): 1 2 3 4 5 6 7 HIGH SCHOOL Year I Year II Year III Year IV NAME AND ADDRESS OF SCHOOL SY ATTENDED NAME AND ADDRESS OF SCHOOL SY ATTENDED

COLLEGIATE Year I Year II Year III Year IV

NAME AND ADDRESS OF SCHOOL

SY ATTENDED

FAMILY BACKGROUND
FATHER NAME CITIZENSHIP HOME ADDRESS TELEPHONE NUMBER OCCUPATION EMPLOYER (Name of Company) BUSINESS ADDRESS TELEPHONE NUMBER HIGHEST EDUCATIONAL ATTAINMENT LAST SCHOOL ATTENDED MOTHER

BROTHERS / SISTERS (Please list from eldest to youngest. Please attach additional sheet if necessary.) NAME AGE CIVIL STATUS SCHOOL YR. LEVEL/YR. GRADUATE

Are you living with parents?

YES NO, please accomplish the Legal Guardianship Form (available online and at the Admissions counter)

Is your father or mother an employee of DLS-CSB? YES NO If YES, who? Father Mother Check classification of specified parent Administrator Faculty Academic Service Faculty Administrative Service Personnel Others (Pls. specify) _________________ Is your father or mother a graduate of any De La Salle School? If YES, who? Father Mother Both If YES, Indicate Father School Level Course Year graduated _______________________ _______________________ _______________________ _______________________ YES NO

Have you, at any time, applied at any College/University/Tertiary School(s)? NO YES (Please answer the questions below.) 1. Name of School: Degree Program Applied To: 2. Name of School: Degree Program Applied To: 3. Name of School: Degree Program Applied To:

Mother _______________________ _______________________ _______________________ _______________________

ADDITIONAL BACKGROUND INFORMATION

Do you have any disability or medical or psychological condition (e.g. asthma, dyslexia, ADD, ADHD, etc.) which may have important bearing on your schooling at DLS-CSB? YES, please specify _______________________________________ (Attach medical records/history/clearance where applicable) NO Is this your first time to apply at DLS-CSB? YES NO ( (State date of previous application: Please indicate your previous application status: Accepted Not Accepted Wait-listed Others (Pls. specify)

EXTRA- and CO-CURRICULAR ACTIVITIES / DEPORTMENT

List honors/awards for academic excellence in school or at special events / distinctions received/special talents and skills: (Please accomplish clearly. DLS-CSB uses this information for merit scholarship screening. Use extra sheet/s if necessary) _____________________________________________________________________________________________________________ _____________________________________________________________________________________________________________ _____________________________________________________________________________________________________________ _____________________________________________________________________________________________________________ _____________________________________________________________________________________________________________ _____________________________________________________________________________________________________________ List memberships in on/off campus organizations: (Please accomplish clearly. DLS-CSB uses this information for merit scholarship screening. Use extra sheet/s if necessary) _____________________________________________________________________________________________________________ _____________________________________________________________________________________________________________ _____________________________________________________________________________________________________________ _____________________________________________________________________________________________________________ _____________________________________________________________________________________________________________ _____________________________________________________________________________________________________________ Were you ever dismissed, suspended, or placed on disciplinary probation? Please give details (dates, offenses, penalties): (Use extra sheet/s if necessary) _____________________________________________________________________________________________________________ _____________________________________________________________________________________________________________ _____________________________________________________________________________________________________________ _____________________________________________________________________________________________________________ _____________________________________________________________________________________________________________

VERIFICATION / AUTHORIZATION
I have carefully read the contents of this application form. I certify that the information given herein is correct and complete. Falsification, misrepresentation, or withholding of information requested in this form will automatically nullify my application and/or subject me to dismissal from De La Salle-College of Saint Benilde. This also authorizes any school I have previously attended to release any information/records requested by De La Salle-College of Saint Benilde in relation to this application. The College may use such information in the processing of this application. Printed Name & Signature of Applicant Printed Name & Signature of Parents(s) / Guardian Date Date

FOR FRESHMAN APPLICANTS ONLY: This is to state that I have never enrolled in any tertiary institution here or abroad after my graduation from high school and after taking the Benildean Entrance Examination (BEE) as part of my application to DLS-CSB.

Printed Name & Signature of Applicant Printed Name & Signature of Parents(s) / Guardian

Date Date

LIST OF DEGREE PROGRAMS AND DEGREE CODES

Please refer to the College Prospectus for complete information on our degree programs. School of Deaf Education and Applied Studies Bachelor in Applied Deaf Studies (Tracks in Multimedia Arts and Entrepreneurship) School of Design and Arts Bachelor of Arts (AB) in Animation AB in Arts Management AB in Digital Filmmaking AB in Multimedia Arts AB in Music Production AB in Photography AB in Production Design AB in Technical Theater AB major in Fashion Design and Merchandising Bachelor of Performing Arts in Dance Bachelor of Science (BS) in Architecture BS in Industrial Design BS in Interior Design School of Hotel, Restaurant and Institution Management* BS in Hotel, Restaurant and Institution Management (Tracks in Culinary Arts, Hospitality Management, & Travel & Tourism Management) BS in International Hospitality Management School of Multidisciplinary Studies AB major in Consular and Diplomatic Affairs School of Management and Information Technology Bachelor of Science in Business Administration (BSBA) major in Computer Applications BSBA major in Export Management BSBA major in Human Resource Management BS in Information Systems BS in Information Technology (with specialization in Game Design and Development) Night Programs offered only to working students BSBA major in Business Management** BSBA major in Marketing Management** BAPDST

ABANI ABAM ABDFILM ABMMA ABMP ABPHOTO ABPRD ABTHR AB-FDM BPAD BS-ARCH BS-ID BS-IND BS-HRIM BS-IHM AB-CDA BSBA-CA BSBA-EM BSBA-HRM BS-IS BS-IT BSBA-BM BSBA-MM

* A partner institution of CHEDs Expanded Tertiary Education Equivalency and Accreditation Program (ETEEAP)