UPLB Form No. 3 (Rev.

2012)

UNIVERSITY OF THE PHILIPPINES LOS BAOS
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. Agricultural Biotechnology [ ] B.S. Economics
[ ] College of Arts and Sciences [ ] College of Engineering and Agro-Industrial
[ ] B.A. Communication Arts Technology
[ ] B.A. Philosophy [ ] B.S. Agricultural and Biosystems Engineering
[ ] B.A. Sociology [ ] B.S. Chemical Engineering
[ ] B.S. Applied Mathematics [ ] B.S. Civil Engineering
[ ] B.S. Applied Physics [ ] B.S. Electrical Engineering
[ ] B.S. Biology [ ] B.S. Industrial Engineering
[ ] B.S. Chemistry [ ] College of Forestry and Natural Resources
[ ] B.S. Computer Science [ ] B.S. Forestry
[ ] B.S. Mathematics [ ] College of Human Ecology
[ ] B.S. Mathematics and Science Teaching [ ] B.S. Human Ecology
[ ] B.S. Statistics [ ] B.S. Nutrition
[ ] CA-CAS Joint Program [ ] College of Veterinary Medicine
[ ] B.S. Agricultural Chemistry [ ] Doctor of Veterinary Medicine*
[ ] College of Development Communication *passing the National Veterinary Admission Test (NVAT) is a
[ ] B.S. Development Communication 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 Attended Location Dates Diploma or Degree Honors 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 Baos.
photograph here

_____________________________
Please sign photograph Signature
at the back
_____________________________
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.