Application Form for This form may be reproduced/photocopied or

Junior High School Grade Seven downloaded at http://www.upv.edu.ph

UNIVERSITY OF THE PHILIPPINES VISAYAS

College of Arts and Sciences
Division of Professional
Education
U.P. HIGH SCHOOL INILOILO
Iloilo City

DEMOCRATIZED ADMISSION POLICY

The University of the Philippines Visayas has adopted a policy of democratized admission for students in
the high schools of the U.P. System. Under this policy, "Every high school in U.P. is a program for helping
economically- disadvantaged but deserving students gain access to tertiary education in U.P."*
In accordance with the UP Policy for Democratization of Admission, the UP High School in Iloilo admits
incoming Grade Seven students from low-income families, or those with an annual income of 250,000 PhP and
below, which makes up 70% of the freshmen population. The change in the Democratized Admission Policy
recommended by the UP System Technical Working Group on Basic Education and duly endorsed by the System
Academic Affairs Committee and the President’s Advisory Council reserves 30% of the freshmen student population
for UP alumni dependents, UP employees’ dependents, and others.

As such, the High School is an experimental laboratory for innovative teaching strategies designed to make
up for this disadvantaged group's training in order to better prepare them for access to tertiary education,
particularly in UP.

IMPLEMENTING GUIDELINES

1. Requirements for screeningapplicants:

a. Applicants must have a weighted average grade of 80 or better for the Grade 4 and Grade 5.
b. Initial qualifiers will be required to take the UPHSI JHS Entrance Examination.

2. Documents required for application (Submit the authenticated documents or attach the scanned copy of
originally authenticated documents if to be submitted online, whenever applicable).

a. Grade 4 and 5 Report Cards certified as true copy by the School Principal;
b. A 2"x 2” photo taken within the last 6 months);
c. Photocopy of Birth Certificate from PSA (formerly NSO);
d. Photograph of the applicant in front of his/her house (Include a sketch of the location of your house on page 4);
e. Information sheet duly accomplished and jointly signed by the student applicant and his/her parent; and
f. Documents on family income (both the mother and the father):
i. For income tax filers, submit photocopies of family Income Tax Returns for the last three
(3) consecutive years (2019, 2020, and 2021);
ii. For those who do not file Income Tax Returns (like tricycle driver, housewife, laborer, etc.), submit a
BIR or LGU certification of gross annual family income for the last two (2) consecutive years (2019,
2020, and 2021);
iii. For recipients of Pantawid Pamilyang Pilipino Program, submit a DSWD certification that your
family is a recipient of the said Program;
iv. For OFWs, submit a POEA-certified true copy of the latest employment contract; and
v. For a solo parent, submit a photocopy of DSWD ID or notarized affidavit stating current marital status.

3. Application and testing fee of ₱170.00.

You may pay at the Cash Office of UPV Iloilo City or Miagao campuses.
4. Duly accomplished forms and attachments may be submitted or mailed to the address below
on or before 20 January 2023:
UP High School in Iloilo
Gen. Luna. St., Iloilo City
5000 Philippines
NOTE: Mailed application forms should be post marked a week before the last day of submission.
5. All applicants must take the U.P. HIGH SCHOOL ADMISSION TEST (UPHSAT) on January 28 or 29, 2023.
*Excerpt from the minutes of the 1018th meeting of the UP Board of Regents held on January 30, 1989
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UNIVERSITY OF THE PHILIPPINES VISAYAS
College of Arts and Sciences
Division of Professional
Education
U.P. HIGH SCHOOL INILOILO
Iloilo City

INFORMATION SHEET FOR GRADE SEVEN APPLICANTS

PHOTO
2" × 2"
Please PRINT all information. Check all appropriate boxes. ID Picture
Do not leave any item unanswered.
I. PERSONAL DATA
Name: Age: Sex:
(Family) (First) (Middle)
Home Address:
Email address: Tel./Cell Phone No.:
Date of Birth: Place of Birth:
Name of School (Elementary):
Type of School: ⎕Public ⎕Private ⎕SUC (State University orCollege)
School Address:
Class Size (No. of Graduating Students):
Honors/Awards (in Grade 5, if any) :
Father’s Name: Age:
Address:
Highest Educational Attainment: Degree Attained:
School: Tel./Cell No.:
Mother’s Name: Age:
Address:
Highest Education Attainment: Degree Attained:
School: Tel./Cell No.:

Number of Children in the family including yourself:

Highest Educational
Name of Brothers/Sisters Age Attainment School

Is your parent a UP employee? Yes

No If yes, please indicate position:

Is your parent a UP graduate? Yes No

If yes, please indicate degree/college/campus?
(Father School/College:
(Mother School/College:
Do you have any other condition/impairment that requiresspecial attention? Yes
No If yes, is it physical?
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psychological?
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Please PRINT all information. Do not leave any item

II. SOCIO-ECONOMIC STATUS
(Note: Please check appropriate box.)
1. On Parent/ Legal Guardian
Gross Annual
Parent Occupation Employer/Address
(Yearly)
Income
Father
Stepfather
Mother
Stepmother
Legal Guardian Total (A)
Are your parents married?
separated?
others,please specify:
2. Other than your parents, do you have any relatives or benefactors, who contribute to the household income?
Yes No
Other household
members Gross Annual
Occupation Employer/Address
(Brothers/Sisters, (Yearly)
Uncle/Aunt, Grandparents, Income
etc.)

Total (B)
3. CombinedGrossAnnualIncomeofyourfamily(AandB)
₱110,000.00 and below ₱180,001.00 –₱210,000.00
₱110,001.00 –₱145,000.00 Above₱210,000.00
₱145,001.00 –₱180,000.00
4. Does your family own or rent the house you are staying in?
Owned (not mortgaged)
Owned (mortgaged) Monthly Amortization: ₱
Rented Monthly Rental: ₱
Neither owned nor rented
NameofOwner:
Relationship of owner toyour family:
5. Generally, what is your house made of?
concrete combination of wood and concrete bamboo w/ galvanized roofing
wood combination of nipa, wood, and bamboo others(specify)
6. Does your family ownany land? Yes No
If yes, whattype?
Residential Commercial Industrial
Agricultural Orchard Fishpond
Others (specify)
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Please PRINT all information. Do not leave any item

7. Do your parents own (a) building(s) aside from your house?

If yes, what type?
Residential Commercial Industrial Agricultural
Others (specify)

8. What appliances/gadget does your family own?

(Indicate the number of appliances you have at home.)
Television Set Microwave Oven Electric Fan
Stereo Component Gas/Electric Range Electric/Hand WaterPump
Personal/Laptop Computer Refrigerator/Freezer Telephone/Cellular Phone
iPad/Tablet Washing Machine Piano/Organ
Smartphone Play Station/iPod/Wii/Xbox Air-conditioning Unit
Others (specify)

9. Does your family own any vehicle for transportation? Yes No

(Indicate the number of vehicles you have.)
Bicycle Motorcycle Pick-up/Van
Tricycle (pedalled/trisikad) Owner-type jeep Truck
Tricycle (motorized) Passenger jeep Car
Others (specify)

If yes, how did your family acquire it?

Brand-new purchase Second-hand purchase
Acquired through Financing / Loan Gift / Handed down by relative
Model: MarketPrice:

10. Does your family engage in any business/ enterprise? Yes No

If yes, specify

11. For Non-Iloilo Cityresidents:

Name of nearest relative in Iloilo City:
Relation (uncle, aunt, etc.)

City Address:
Tel./ Cel. No.

I hereby certify to the correctness of the information given in this application form.

Signature over Printed Name of Applicant Signature over Printed Name of Parent/Guardian

Date Date

Note: The information above on socio-economic status is subject to further verification by the Admission
Committee. Any misinformation from the applicant may serve as ground for his/her disqualification for
admission.
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12. ON THE SPACE PROVIDED BELOW, PLEASE MAKE A SKETCH OF THE LOCATION
OF YOUR HOUSE. INCLUDE PROMINENT LANDMARKS WITH THEIR NAMES (e.g.,
SARI-SARI STORE, BUSINESS ESTABLISHMENT, ETC.)

MIAGAO CHURCH

SLMSM

QUEZON STREET

LABRADOR
RESIDENCE

MAT-Y BRGY. HALL

REYBAN’S
STORE
FASOMINGO
PHARMACY

DR. MARTINETE
MEDICAL CLINIC
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CERTIFICATION OF OFFICIAL GRADES

Applicant’s Name:

(First Name) (Middle Name) (Last name)

Final Grades in Grade 4

Subjects Final Grade

Mathematics
Science
Social Studies
Filipino
English

Final Weighted Average Grade in all

Subjects of Grade 4

Final Grades in Grade 5

Subjects Final Grade

Mathematics
Science
Social Studies
Filipino
English

Weighted Average Grade in all Subjects in

First Grading of Grade 5

Honors/Awards (in Grade 4, if any)

□ With Highest Honors
□ With High Honors
□ With Honors

Honors/Awards (in Grade 5, if any)

□ With Highest Honors
□ With High Honors
□ With Honors

Certified True and Correct:

School Principal’s Signature over Printed Name SCHOOL’S

OFFICIAL DRY SEAL

Name of School: