UP Form No. 3A (Rev.
September 2023)
University of the Philippines Diliman
OFFICE OF THE UNIVERSITY REGISTRAR
Diliman, Quezon City 1101 SUBJECT TO AVAILABILITY OF SLOTS
Philippines Do not write inside the boxes
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ADMISSION APPLICATION Application fee __P150 __$30 __P100
Staple 2 recent (Non-refundable)
2”x2” photographs PMO/Cashier’s or Manager’s Check
here O.R. No________________________
Date _____________ By __________
Print and sign over printed UNDERGRADUATE EVALUATION
name INTERNATIONAL GWA __________ Units __________
at the back of the photographs (NON-REGULAR STUDENTS) Degree ________________________
_______Semester/School Year_________ Referred to _____________________
_______________________________
NAME
_____________________________________________________________________________________________________
LAST FIRST MIDDLE MAIDEN
SEX ASSIGNED AT BIRTH Female Male Others__________ CITIZENSHIP ____________ RELIGION ____________
CIVIL STATUS Single Married others _________________If married, name of Spouse _________________________
E-MAIL ADDRESS/
DATE OF BIRTH ____________________ PLACE OF BIRTH _______________________ CONTACT NOS. ___________________
PERMANENT HOME ADDRESS ____________________________________________________________________________
CURRENT ADDRESS ____________________________________________________________________________________
NAME OF FATHER__________________________________ NAME OF MOTHER ______________________________________
STATUS NON-DEGREE STUDENT SPECIAL STUDENT WITHOUT CREDIT
(Will earn credits for subjects taken in UP) (Will not earn credits for subjects taken in UP)
CROSS-REGISTRANT
(Currently enrolled in a non-UP school; will earn credits from UP)
SPECIFIC SUBJECTS APPLIED FOR
(for non-degree, special, or cross-registrant students only)
____________________ _________________________ _________________________
____________________ _________________________ _________________________
COLLEGE/S ATTENDED:
Name of School(s) Location Sem(s) & Year(s) Attended Degree Pursued Date of Graduation
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
Have you ever been subjected to academic or disciplinary action (i.e. probation, suspension, dismissal, expulsion) from any
institution attended? Yes No If Yes, explain giving the dates and other details:_____________________________
_____________________________________________________________________________________________________
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.
_______________________________ ________________________
Signature Date
I have read the University of the Philippines' Privacy Notice for Students.
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 Diliman.
I likewise consent to and recognize UP's authority to post online and/or in UP bulletin boards at its
option my name and program in the event I qualify for admission in order for the University to
comply with its Charter and uphold the principle of transparency in the admissions process.
______________________________________ ______________________________________
Signature of the student over printed name Signature of Parent/Guardian over printed name
if applicant is a minor
Date: ____________________________________ Date:______________________________________
