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Manual Application Form

The document is an applicant information sheet for admission to De La Salle University. It requests personal information such as name, date of birth, citizenship, contact details, as well as academic information like previous high school attended. The applicant must also declare if they have any physical or behavioral conditions, or have been subjected to disciplinary action. By signing, the applicant certifies that the information provided is correct and understands falsification could nullify their application or lead to dismissal.

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Julius Anthony Magallon
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264 views

Manual Application Form

The document is an applicant information sheet for admission to De La Salle University. It requests personal information such as name, date of birth, citizenship, contact details, as well as academic information like previous high school attended. The applicant must also declare if they have any physical or behavioral conditions, or have been subjected to disciplinary action. By signing, the applicant certifies that the information provided is correct and understands falsification could nullify their application or lead to dismissal.

Uploaded by

Julius Anthony Magallon
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Form No.

UG-04
Office of Admissions
and Scholarships

APPLICANT INFORMATION SHEET

Reference Number AY 2 0 1 8 - 1 9

*Please print all information requested.


APPLICATION DETAILS
Application Type (Check one answer only)
Filipino Citizen including those who are Dual Citizens (Php 600.00)

Non-Filipino Citizen (Php 2,500.00)

Graduating or Graduate of Philippine Public/Science High School (FREE)

Degree Program Choices (Choose preferred campus)


First Choice DLSU Manila DLSU-STC
Second Choice DLSU Manila DLSU-STC

Third Choice DLSU Manila DLSU-STC

PERSONAL INFORMATION
Applicant Name (Please use legal name as it appears on your birth certificate)
Last Name Nick Name
Given Name
Middle Name

Date Of Birth MM/DD/YYYY


Place Of Birth

Gender Civil Status

Religion
Country Of With Dual Citizenship:
Country Of Secondary
Citizenship Citizenship

Phone Number: Mobile Number:


Country Code / Area Code / Number Country Code / Area Code / Number

Primary E-Mail Address


(Please write legibly)

Address (Please write address as it would appear on a letter envelope).


Unit Address
Unit Number Name Of Apartment/Townhouse/Condominium Building

Street Address
Number Street Name Subdivision Name Barangay

District/City/Province
District City/Town Province Region/Estate

Country Postal Code


2401 Taft Avenue, 1004 Manila, Philippines I Tel: (632) 523-4230 | Trunk Line: (632) 524-4611 loc. 166
[email protected] I www.dlsu.edu.ph
Office of Admissions
and Scholarships

ACADEMIC INFORMATION
Last High School Attended School Year Attended
School Name -
Address
Senior High School Track

DECLARATIONS
Do You Have A Physical Condition Which May Affect Your Performance In College?

Yes, if yes please state the physical condition:


No

Do You Have A Behavioral Condition Which May Affect Your Performance In College?
Yes, if yes please state the physical condition:

No
Have You Been Subjected To Any Disciplinary Action?

Yes, if yes please state the disciplinary action:


No

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/expulsion from the University.

Signature over Printed Name Date

2401 Taft Avenue, 1004 Manila, Philippines I Tel: (632) 523-4230 | Trunk Line: (632) 524-4611 loc. 166
[email protected] I www.dlsu.edu.ph

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