This document is an application form for admission to the Professional Teacher Certification Program at the University of the Philippines Open University. It lists the required documents for application, which include a completed application form, transcripts, photos, and proof of payment of the application fee. It requests personal information such as name, address, educational and employment background. It provides instructions for payment of the application fee via deposit at the Philippine National Bank or using a credit card at certain learning centers.
This document is an application form for admission to the Professional Teacher Certification Program at the University of the Philippines Open University. It lists the required documents for application, which include a completed application form, transcripts, photos, and proof of payment of the application fee. It requests personal information such as name, address, educational and employment background. It provides instructions for payment of the application fee via deposit at the Philippine National Bank or using a credit card at certain learning centers.
This document is an application form for admission to the Professional Teacher Certification Program at the University of the Philippines Open University. It lists the required documents for application, which include a completed application form, transcripts, photos, and proof of payment of the application fee. It requests personal information such as name, address, educational and employment background. It provides instructions for payment of the application fee via deposit at the Philippine National Bank or using a credit card at certain learning centers.
This document is an application form for admission to the Professional Teacher Certification Program at the University of the Philippines Open University. It lists the required documents for application, which include a completed application form, transcripts, photos, and proof of payment of the application fee. It requests personal information such as name, address, educational and employment background. It provides instructions for payment of the application fee via deposit at the Philippine National Bank or using a credit card at certain learning centers.
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UPOU Form No.
1d
APPLICATION FOR ADMISSION TO PROFESSIONAL TEACHER CERTIFICATION (PTC) PROGRAM University of the Philippines OPEN UNIVERSITY Los Baos, Laguna 4031 Philippines
This application shall not be acted upon unless the following documents are received by the Office of the University Registrar, UP Open University, Los Baos, Laguna, on or before February 28 for the first semester admission and June 30 for entry in the second semester term: 1. Correctly and completely accomplished application form 2. Photocopy of valid Transcript of Records (TOR) for all degrees earned 3. Two recent 2"x2" and two 1"x1" identical colored photos with plain white background (print complete name at the back) 4. Proof of payment of application fee (Php 500.00 for Philippine-based applicants or US$100.00 for overseas applicants) (see payment procedure)
What Learning Center / Testing Center is most accesible to you?
(For list of Learning Centers/ Testing Centers visit www.upou.org)
A. PERSONAL DATA 1
Please print Family First 4
NAME Middle 6
GENDER
AGE 8
DATE OF BIRTH
BIRTHPLACE 9
CITIZENSHIP
Male 7
Female PRESENT OCCUPATION/POSITION EMPLOYER
CIVIL STATUS
Single Widow/er 10
Married Separated 11
Private Semi-Private HOME ADDRESS
Government Others:
OFFICE ADDRESS
Tel. No: Zip Code: Fax No:
12
Province: Region: 13
Tel. No: Zip Code: Mobile No:
Province: Region:
PREFERRED MAILING ADDRESS:
E-MAIL ADDRESS (required)
14
Office Home Name, address and tel. no. of person to be notified in case of emergency:
B. EMPLOYMENT BACKGROUND 15
Indicate the three (3) most recent occupational experience.
Name & Address of Employer Position From
Please use additional sheet if necessary.
Date
To
Brief Description of Duties
16
Subject(s) currently handled or planning to handle in the future
17
No. of years working/teaching (if applicable)
18
FINANCIAL SUPPORT:
Parents
Self
Loan
Scholarship
Others:
C. EDUCATIONAL BACKGROUND 19
Have you been previously enrolled in the University of the Philippines? If yes, UP student number: Regular Non-degree Special What program/degree? Others: Are you currently enrolled in another college/university? If yes, in what program/degree? Institution: Institution(s) Attended Degree Major Field Yes
Yes
No
20
No
21
List tertiary and graduate schools previously attended.
From
Inclusive Date
To
22
Academic Honors, Awards and Scholarship.
Award
Please use additional sheet if necessary.
Institution Conferring Award
Date Conferred
23
Professional, Licensure and Civil Service Examination Taken: Title of Examination
Date Taken
Rating
24
Membership in honor, professional and community organization. Please use additional sheet if necessary. Inclusive Date Organization Nature of Organization Position Held From
To
Student Declaration: I hereby affirm that all information supplied herein is complete and accurate. Witholding 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 regulations of the UP Open University. Please attach 2 x 2 photo here.
Please paste. Do not staple. Signature Date
PAYMENT PROCEDURES: PNB Payment System: 1. Go to the nearest Philippine National Bank (PNB) Branch and ask for an Inter-Office Savings/Checking Account Deposit slip. 2. Fill in three (3) deposit slips completely. Depository Office: PNB-UP Los Baos Branch Credited to Account No.: 075-800050-8 Name of Depositor: UPOU Revolving Fund 3. Print your name, purpose of payment (i.e. APPLICATION FEE) and the program you are applying for at the bottom part of the slip. 4. Obtain two copies of the bank validated deposit slips of the required fee. 5. Attach one copy of the validated deposit slip to your application form. (Only those with original copies of the PNB teller-validated receipt will be issued Official Receipts. All monetary transactions are made through the bank.) Credit Card Payment System: 1. Payment of school and other fees through the use of credit card can be done right at the following Learning Centers: UP Diliman, UP Manila, UP Baguio, UP Los Baos, UP in the Visayas, UP College Cebu, UP Tacloban College, and UP Mindanao. 2. The following credit cards will be honored: Visa, Mastercard, JCB and American Express. 3. A 3% transaction cost for Over-The-Counter transactions will also be charged to you. 4. The transaction receipt will serve as your proof of payment and will be attached to your application form. 5. Please take note that this mode of payment is an ALTERNATIVE to bank payment through PNB.
