Application no.

Exam date

Paste your 2x2 picture here

School Year Legal name

(Name in Birth Certificate) Last/Family First/Given Middle/Complete

Female Male

Nickname Present school INSTRUCTIONS

1. Read the Admissions Brochure and all instructions carefully. 2. Fill out this form carefully and print or type all information requested. Write N/A if the information is not applicable to you. Omissions can delay the processing of your application. 3. Please make sure to complete all the requirements in order to facilitate the processing of your application. 4. Submit this form together with the following documents: a) Secondary school record, b) Recommendation form, c) Personal essay (printed on a short bond paper), d) NSO- authenticated Birth Certificate, e) three 2x2 identical pictures and f) Accomplished Scholarship/ Financial aid form for those applying for grants. 5. The Application fee is non-refundable.

PERSONAL INFORMATION Complete permanent address (Foreign students should specify their address at their country of origin)

Zip code Mailing address

(if not the same as above)

Telephone number E-mail address Birth date

(mm)

Zip code Fax number Mobile number

/
(dd)

/
(yyyy)

Place of birth Others (pls. specify) Dual (pls. specify) Religion

Citizenship

Filipino

If married, name of spouse

(submit a copy of your marriage contract)

Does your family own a business?

Yes

No

If yes, specify name and nature of business

FAMILY INFORMATION Father's name

Last/Family First/Given Middle

Mother's name
Last/Family First/Given Middle

Name of company/ employer Present occupation/ position Address

Name of company/ employer Present occupation/ position Address

Business phone ( College (if any) Degree Graduate school (if any) Degree

Mobile

Business phone ( College (if any) Year Degree

Mobile

Area Code

Area Code

Year

Graduate school (if any) Year Degree Year

Sibling/s' educational attainment (eldest to youngest) Name 1 2 3 4 5 Age Highest educational attainment Last school attended

SCHOLASTIC INFORMATION List all honors and awards you have received for academic excellence and co-curricular activities in high school. Indicate when you received these.

List all the co-curricular organizations you have participated in. Indicate the position(s) held and year level(s) when you were in office. (ex. Dramatics Club: Member I, II, Vice President-III; President- IV)

What special training program(s) or seminar(s) have you attended?

Have you failed any subject(s) in high school or college at the end of a term? If yes, please indicate the failed subject(s), year level(s), and reasons.

Yes

No

Have you repeated a year in high school?

Yes

No

Which year level? Why?

Have you ever been forced to stop schooling for at least a month because of health reasons? If yes, please give details.

Yes

No

Please explain any gaps in school history, i.e. times you were not enrolled in any school. (if employed, please submit a certification of employment)

Were you ever dismissed, suspended or placed under disciplinary probation? If yes, please indicate offense(s) and sanction(s).

Yes

No

List all your sports, hobbies, interests, special skills and talents.

On a short bond paper, type an essay that conveys your interests (visual/ theater arts, sports, music, gourmet cooking, etc.), accomplishments; family, educational, entrepreneurial, and social experiences; future goals, including your strengths, weaknesses and your potentials which will positively contribute to the development of the University (maximum of 250 words).

PROGRAM PREFERENCE

1. Please choose either the Five-year Combined Undergraduate and Graduate Programs or the Four-year Undergraduate Bachelor's Programs. 2. Indicate your preferred course by specifying your first and second choice in the boxes provided in the chosen program (Five-year or Four-year)

Five-Year Combined Undergraduate and Graduate Programs Master of Arts in Humanities Master of Arts in Political Economy with Specialization in International Relations & Development Master of Science in Industrial Economics Master of Science in Management Four-Year Undergraduate Programs Bachelor of Science in Entrepreneurial Management Bachelor of Science in Industrial Engineering (5 years) Bachelor of Science in Applied Mathematics Bachelor of Science in Business Administration Major in Management Bachelor of Science in Child Development and Education Bachelor of Science in Information Technology Bachelor of Arts Major in Humanities Bachelor of Arts Major in Economics Bachelor of Arts Major in Political Economy Bachelor of Arts Major in Integrated Marketing Communications Bachelor of Science in Human Capital Development Major in Organizational Learning and Psychology *

* Permit in process Note: Applicants to the Entrepreneurial Management Program have to take a diagnostic exam for an additional fee of P250.00 CERTIFICATION

I hereby certify that I have read and fully understood all instructions regarding my application for admissions at UA&P and that the information supplied in this application and the documentation supporting it are correct and complete. I understand that incomplete or inaccurate information could be prejudicial to my admission. If accepted as a student of the University of Asia and the Pacific, I agree to abide by all its policies and regulations.

APPLICANT'S SIGNATURE

DATE