UPLB Form No.

3 (Rev 2023)

UNIVERSITY OF THE PHILIPPINES LOS BAÑOS

OFFICE OF THE UNIVERSITY REGISTRAR
G/F CAS Annex I Building, 4031 College, Laguna, Philippines

UNDERGRADUATE ADMISSION APPLICATION

NAME
______________________________________________________________________________________________________________
Last First Middle
SEX assigned at birth ( ) Female ( ) Male CIVIL STATUS: ( ) Single ( ) Married

DATE OF BIRTH _____________________________ If married, name of spouse _____________________________________

PLACE OF BIRTH ___________________________________________ CITIZENSHIP ( ) Filipino ( )Non-Filipino_____________

PERMANENT HOME ADDRESS _________________________________________________________________________________
_

CURRENT ADDRESS ___________________________________________________________________________________________

CONTACT NUMBER _______________________________ E-MAIL ADDRESS ________________________________________

Check appropriate blank below:

APPLYING FOR ADMISSION AS: FOR ADMISSION STARTING:
[ ] Beginning New First Year
(high school graduate with no college credit) [ ] First Semester, ______________
[ ] Transfer Student [ ] Second Semester, ____________
(with at least 33 academic units from another college)
[ ] Non-Degree Student Specific Subjects Applied For:
(will earn credits for subjects taken at UPLB) (For non-degree and special students only)
[ ] Special Student _________________________________
(will not earn any credit for subjects taken at UPLB) _________________________________
[ ] Second Degree _________________________________
College/Course Program applying for: (*closed to non-UP applicants)

[ ] College of Agriculture and Food Science [ ] College of Economics and Management

[ ] B.S. Agriculture [ ] B.S. Accountancy
[ ] B.S. Agricultural Biotechnology [ ] B.S. Agribusiness Management & Entrepreneurship
[ ] B.S. Food Science and Technology [ ] B.S. Agricultural and Applied Economics
[ ] B.S. Economics
[ ] College of Arts and Sciences [ ] College of Engineering and Agro-Industrial Technology
[ ] B.A. Communication Arts [ ] B.S. Agricultural and Biosystems Engineering
[ ] B.A. Philosophy [ ] B.S. Chemical Engineering*
[ ] B.A. Sociology [ ] B.S. Civil Engineering*
[ ] B.S. Applied Mathematics [ ] B.S. Electrical Engineering*
[ ] B.S. Applied Physics [ ] B.S. Industrial Engineering*
[ ] B.S. Biology [ ] B.S. Materials Engineering*
[ ] B.S. Chemistry [ ] B.S. Mechanical Engineering*
[ ] B.S. Computer Science* [ ] College of Forestry and Natural Resources
[ ] B.S. Mathematics [ ] B.S. Forestry
[ ] B.S. Mathematics and Science Teaching [ ] College of Human Ecology
[ ] B.S. Statistics [ ] B.S. Human Ecology
[ ] CA-CAS Joint Program [ ] B.S. Nutrition
[ ] B.S. Agricultural Chemistry [ ] College of Veterinary Medicine
[ ] College of Development Communication [ ] Doctor of Veterinary Medicine
[ ] B.S. Development Communication

If you are admitted, will it be your first enrolment in UP? [ ] Yes [ ] No

If no, please answer the following:
UP College(s) Attended Semester(s) & Schoolyear(s) Attended Course Classification
(regular, non-degree or special)
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
 FATHER [ ] Living MOTHER [ ] Living GUARDIAN/SPOUSE
[ ] Deceased [ ] Deceased

Name _______________________________ ________________________________ _____________________________

Address _____________________________ ________________________________ _____________________________
Telephone No.________________________ ________________________________ _____________________________
E-mail Address _______________________ ________________________________ _____________________________
Business Address _____________________ ________________________________ _____________________________
Occupation __________________________ ________________________________ _____________________________

FINANCIAL SUPPORT:
[ ] Parents [ ] Self [ ] Loan [ ] Scholarship [ ] Other, Specify:____________________

PERSON TO BE NOTIFIED IN CASE OF EMERGENCY:

Name ________________________________________________ Relationship____________________________________

Address ______________________________________________ Telephone No.__________________________________

List in chronological order all schools* attended starting from secondary school:
Name of School Attended Location Dates Diploma or Degree Honors Received
__________________________ _________________ _____________ ____________________ _________________
__________________________ _________________ _____________ ____________________ _________________
__________________________ _________________ _____________ ____________________ _________________
* Transcript of records or true copy of grades duly certified by appropriate school authorities in all institutions attended should be sent to
the UPLB Office of the University Registrar, 4031 College, Laguna, Philippines. This application will not be considered unless these
records are received. Secondary school records are needed only for those applying for admission as new freshmen.

Are you presently enrolled? [ ] Yes [ ] No

If yes, in what school are you enrolled?__________________________________________________________________

Have you ever been subject to academic or disciplinary action (i.e. probation, suspension, dismissal) from any institution
attended? [ ] Yes [ ] No
If yes, please explain giving the dates and other details: ___________________________________________________________
Non-Filipino students: Immigration status _____________________________ ACR/ICR No. ____________________________
Date Issued___________________________________ Where Issued_____________________________

For applicants from non-English speaking countries, submit the TOEFL score along with your academic records as part of
your application credentials.

I have read the University of the Philippines’ Privacy Notice for Students (Please go to website: our.uplb.edu.ph)
I grant my consent to and recognize the authority of the University of the Philippines to process my personal and
sensitive personal information pursuant to the abovementioned Privacy Notice and applicable laws in connection with my
application to shift/transfer/be admitted as a student of UP (please indicate which is applicable).

I hereby affirm that all information supplied herein is

complete and accurate. Withholding 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 University of the
Philippines Los Baños.
Attach a recent
2" x 2" photograph here
_____________________________
Please sign photograph Signature
at the back
_____________________________
Date

IMPORTANT NOTICE:
Evaluation of application for admission will be made upon submission of all official copy of grades/examination
certificates or transcript of all collegiate courses enrolled in.