UPOU Form No.

1
APPLICATION FOR ADMISSION TO GRADUATE PROGRAMS Revised Jan. 2010

University of the Philippines

OPEN UNIVERSITY
Los Baños, 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 Baños, Laguna, on or before What program are you
January 31 for MPM, PhD & AA applicants, February 28 for all other programs for entry in the first applying for?
semester and June 30 for entry in the second semester for the next academic year:
1. Correctly and completely accomplished application form Program: _____________
2. Original copy of valid Transcript of Records (TOR) for all degrees earned and one (1) ____________________
set photocopy. Major: ______________
3. Two (2) letters of recommendation from: a) employer/supervisor; b) former professor; or
c) former program adviser [please use UPOU Form 1a] What learning center is
4. Two recent 2"x2" and two 1"x1" identical colored photos with plain white background most accesible to you?
(print complete name at the back) Learning Center: _______
5. Proof of payment of application fee (Php 500.00 for Philippine-based applicants or
US$100.00 for overseas applicants) (see payment procedure)
6. 500-word essay (please refer to No. 30 of this form) (For list of Learning Centers
7. Photocopy of marriage certificate for married female applicant visit www.upou.edu.ph)
*PhD(Educ) and MPM have additional examination fees

A. PERSONAL DATA Please print

1
NAME
Family First Middle
2 3 4 5 6
GENDER AGE DATE OF BIRTH BIRTHPLACE CITIZENSHIP

Male
Female
7 8 9
CIVIL STATUS PRESENT OCCUPATION/POSITION EMPLOYER

Single
Married
Private
Government

Widow/er
Separated
Semi-Private
Others:
10 11
OFFICE ADDRESS HOME ADDRESS

Tel. No: Province: Tel. No: Province:

Zip Code: Region: Zip Code: Region:
Fax No: Mobile No:
12 13
PREFERRED MAILING ADDRESS: E-MAIL ADDRESS:

Office
Home
14
Name, address and tel. no. of person to be notified in case of emergency:

15
Additional Personal Information:
Father Mother Spouse/Guardian
Full Name:
Home Address:

Tel. No.
16
Do you have any physical and learning disabilities? Are you seeing a psychiatrist (please be informed that the university
is extending assistance on this matter), (e.g hearing impairment, seeing defect, etc.)
Yes
No
If yes, please specify:

1
B. EMPLOYMENT BACKGROUND
17
Indicate the three (3) most recent occupational experience. Please use additional sheet if necessary.
Name & Address of Employer Position Date Brief Description of
From To Duties

18 19
Subject(s) currently handled (for teacher applicants only) No. of years working/teaching

20
FINANCIAL SUPPORT:
Parents
Self
Loan
Scholarship
Others:

C. EDUCATIONAL BACKGROUND

Yes
No
21
Have you been previously enrolled in the University of the Philippines?
If yes,
Regular
Non-degree UP student number:

Special
Others: What program/degree?
22
Are you currently enrolled in another college/university?
Yes
No
If yes, in what program/degree?
Institution:
23
List tertiary and graduate schools previously attended.
I nstitution(s) Attended Degree Major Field Inclusive Date
From To

24
Academic Honors, Awards and Scholarship. Please use additional sheet if necessary.
Award Institution Conferring Award Date Conferred

25
Professional, Licensure and Civil Service Examination Taken:
Title of Examination Date Taken Rating

26
Membership in honor, professional and community organization. Please use additional sheet if necessary.
Nature of Organization Position Held Inclusive Date
Organization From To

2
 27
Publications. Please use additional sheet if necessary.
Title of Publication Date Published

28
Unpublished papers or theses. Please use additional sheet if necessary.
Title of Paper Date Written

29
References. List down names, positions and addresses of the persons whom you have requested to recommend you.
Name Position Address

30
Write an essay of about 500 words indicating your purpose for applying to the distance education
programs and your plans after completion of graduate study at the UP Open University.

Student Declaration:
For applicants to the MPM program
Preferred Testing Centers for Graduate Admission Test: “ I hereby affirm that all information supplied herein is complete

UP Cebu College
UP College Baguio and accurate. Witholding or giving false information will make

UP Diliman
UP Los Baños me ineligible for admission or subject to dismissal. If admitted,

UP Mindanao
UP Tacloban College I agree to abide by the policies rules and regulations of the

UP Visayas (Iloilo Campus) UP Open University.”

PAYMENT PROCEDURE:
1. Go to the nearest Philippine National Bank (PNB) Branch and ask for a
Bills Payment slip.
2. Fill in three (3) slips completely. Please attach
Name of Institution: UP Open University 2” x 2” photo here.
Signature
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 slips of the required fee.
5. Attach one copy of the validated slip to your application form. Please paste.
(Only those with original copies of the PNB teller-validated receipt will be Do not staple.
issued Official Receipts. All monetary transactions are made through Date
the bank.)
For those with no UP student number yet, please use:
Y E A R - 83000 (e.g. 2009-83000)

For payment outside the Philippines, use the following accounts:

Peso Account: UPOU Revolving Fund
Account No.: 399 6931-00012
Dollar Account: UPOU Trust Fund (USD)
Account No.: 399 6929-00011

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 University of the Philippines
OPEN UNIVERSITY
Graduate Degree Program Offerings

Faculty of Education Faculty of Management and

The Diploma in Science Teaching (DST) is a post-baccalaureate Development Studies
degree program designed for science teachers at the secondary school
The Diploma/Master in Environment and Natural Resources
level, those teaching introductory science courses at the tertiary level. The
Management (D/MENRM) offers a ladder-type program designed to provide
program has three areas of specialization: Biology, Chemistry, and Physics.
professionals involved in environment-related activities with a solid foundation
The Diploma in Mathematics Teaching (DMT) aims to upgrade
in the art and science of environment and natural resources management, as
the mathematics and pedagogical competencies of mathematics teachers in
well as a multidisciplinary perspective.
the secondary schools, as well as those engaged in mathematics curriculum
The Master in Public Management (MPM) aims to upgrade the
and materials development.
administrative skills and professional competence of policy makers, public
The Diploma in Social Studies Education (DSSE) aim to improve
managers, administrators, practitioners of local government and administration,
the teaching competencies of educators teaching Sibika at Kultura and Hekasi
and individuals interested in good governance, public policy, and
in the elementary schools and social studies in the secondary schools. It is
administration.
also intended for division supervisors and curriculum developers in social
The Master of Arts in Nursing (MAN) program is designed to prepare
studies.
qualified nurses in the Philippines and abroad for clinical specialization and
The Diploma in Language and Literacy Education (DLLE) is a
leadership in any of the major fields of adult health nursing, community health
post-baccalaureate program that aims to upgrade and update the knowledge
nursing, maternal and child health nursing, and nursing administration.
and competencies of language and reading teachers. It is designed for
The Master of Hospital Administration (MHA) program aims to
teachers whose undergraduate training was not in English studies (including
provide hospital administrators and managers with an opportunity for
literature) or reading or language education.
continuing education and innovative advancement.
The Master of Arts in Education (Social Studies) program is
The Master of Public Health (MPH) program aims to provide
likewise designed to improve the teaching competencies of educators teaching
continuing education and career development to health workers, particularly
Sibika at Kultura and Hekasi in the elementary schools and social studies in
those in the countryside, that will enable them to critically assess and deal with
the secondary schools, division supervisors and curriculum developers in
a spectrum of public health programs.
social studies. The program is laddered on to the Diploma program.
The Diploma in Social Work and Master of Social Work
The Master of Arts in Education (Language and Literacy
(D/MSW) answer the demand of social work practitioners for upgrading
Education) program is designed to upgrade and update the knowledge
through advanced degrees. As a response to the current need and demand
and competencies of language and reading teachers. It is laddered on to
for the D/MSW program, a distance education program can reach a very
the DLLE program.
large number of students in as many areas as possible with minimal resources
The Master of Distance Education (MDE) is composed of six core
needed.
courses (18 units) and four electives (12 units), with at least one elective
course from each of the following clusters: Pedagogy, Technology
Applications, and Educational Management. The capstone course is a 4-
Faculty of Information and
unit project (Special Problem in Distance Education). Passing a Communication Studies
comprehensive examination is required before enrollment in the Special The Diploma in Computer Science (DCS) addresses the need for
Problem course. advanced training of personnel in information systems. It targets corporate
The PhD in Education is intended primarily for teacher educators, information officers, EDP personnel, programmers, software developers
policy makers, researchers, and other educational personnel involved in and teachers with minimal training in the field of computer science.
science and mathematics education. The program aims to upgrade the The Master of Development Communication ( MDC) is a 2 1/2-
capabilities of Regional Science Teaching Centers (RSTCs) and other year graduate degree program for communication professionals and
Teacher Education Institutions (TEIs). There are four areas of specialization: graduates. It aims to provide communication professionals with a firmer
Biology, Chemistry, Physics, and Mathematics. foundation in development communication theory as well and the necessary
The Professional Teacher Certification (PTC) program provides skills in development communication work.
non-education graduates, who intend to teach, with 18 units of professional The Master in Information Systems (MIS) program is designed to
education courses. Education courses will be on educational psychology, provide students with advanced knowledge in information systems (IS)
principles and techniques of teaching, principles of education, measurement, concepts such as internetworking, strategic (IS) planning, and IS
and evaluation, practicum, and special education or organization and development.
management of educational institutions.

Faculty of Management and For more information, please inquire

Development Studies at the Office of the University Registrar:

The Diploma in Research and Development Management Tel. No.: (6349) 536-6001 to 06 loc. 102, 101 or 199
(DR&DM) is designed to enhance knowledge and skills in planning R&D Telefax No.: (6349) 536-6012
programs; developing and promoting technologies for utilization; and Email: [email protected]
managing human and organizational relations in R&D systems. It is primarily Website: www.upou.edu.ph
directed towards managerial leadership development.