College Admissions Office

Br. Andrew Gonzalez Hall

De La Salle University
2401 Taft Avenue, Manila 1004
Telephone Nos. 5234230 (Direct); 5244611 loc 166 and 167
Undergraduate Application Form
Email: [email protected]
Website: www.dlsu.edu.ph

PRINT OR TYPE all information and attach one 2x2 photograph as indicated on the right.
Submit this form together with the other requirements to the DLSU College Admissions Office
for your Entrance Examination schedule. ONLY APPLICATIONS ACCOMPLISHED
Attach 2”x2” photo here
CORRECTLY AND COMPLETELY WILL BE PROCESSED.

Application is made as a Freshman student Transfer student 2nd undergraduate degree student
For the 1st Trimester  2nd Trimester  3rd Trimester School Year______________________

PERSONAL DATA

LAST NAME

FIRST NAME NICKNAME

MIDDLE NAME

PERMANENT MAILING
ADDRESS
POSTAL CODE

E-MAIL ADDRESS TEL NO. ( ) MOBILE NO.

DATE OF BIRTH PLACE OF BIRTH AGE SEX

mo. day year

CITIZENSHIP RELIGION CIVIL STATUS

EDUCATIONAL BACKGROUND
SCHOOL YEAR
GRADE SCHOOL NAME AND ADDRESS OF SCHOOL REGION
ATTENDED
Grade(s):1
2
3
4
5
6
7

HIGH SCHOOL
Year I
II
III
IV

COLLEGIATE COURSE
Year I
II
III
IV

INTENDED DEGREE PROGRAMS:

(Refer to the separate Undergraduate Degree Programs course listing for the Degree Code)

DEGREE CODE

FIRST CHOICE SECOND CHOICE THIRD CHOICE

DO NOT FILL

HS GPA REFERENCE NO.

L R S M MA T
RS
PR
 LAST NAME FIRST NAME MIDDLE NAME

FAMILY BACKGROUND
FATHER MOTHER
NAME
CITIZENSHIP
HOME ADDRESS
E-MAIL ADDRESS
HOME TELEPHONE NO.

MOBILE PHONE NO.

OCCUPATION
EMPLOYER
BUSINESS ADDRESS
OFFICE TELEPHONE NO.
EDUCATIONAL ATTAINMENT

LAST SCHOOL ATTENDED

Is your father or mother an employee of DLSU? Yes No If YES, who? Father Mother
Kindly check the classification of specified parent:

Administrator Faculty Academic Service Faculty Administrative Service Personnel Co-academic Personnel
Number of years of service
Is your father or mother an alumnus/alumna of DLSU? Yes No If YES, who? Father Mother
If Yes, kindly indicate
Level Grade School High School College Graduate School
Year Graduated
Degree
HOW MUCH IS YOUR ANNUAL FAMILY INCOME 500,000 and below 500,001 - 650,000 650,001 - 800,000 800,001 and above
ALTERNATE CONTACT PERSON
MAILING ADDRESS
TEL. NO. MOBILE NO. E-MAIL ADDRESS
BROTHERS and SISTERS (Please list from eldest to youngest)
YEAR LEVEL
NAME AGE CIVIL STATUS SCHOOL COURSE YEAR GRADUATED

Honors/Awards/Distinctions Received

Is this your first time to apply at DLSU? Yes No If NO, date of previous application
Reasons for applying at DLSU

Where did you get the information about DLSU? DLSU Website Ads
Bulletin Boards Others, pls. specify
SCHOLARSHIP and FINANCIAL ASSISTANCE
Freshman applicants who wish to apply for Financial Assistance/Scholarship at DLSU (DOST grants included) MUST REQUEST for an
application form for financial assistance at the College Admissions Office, and TOGETHER with this application form, submit all the other
requirements.

Have you applied for scholarship in an outside agency? Yes No If YES, Name of Agency

CERTIFICATION
I certify that the information given herein is correct and complete. Falsification or withholding of information on this form will automatically
nullify my application and/or subject me to dismissal from the University.

Signature above printed name Date