REGISTRAR'S

DEAN'S
COPY

UPOU FORM 5 UNIVERSITY OF THE PHILIPPINES OPEN UNIVERSITY CERTIFICATE OF REGISTRATION (Rev July 2010)
WRITE IN BLOCK LETTERS. Use an X in answering information preceded by a box.
PLEASE WRITE LEGIBLY
STUDENT NUMBER

COURSE/S

ASSESSMENT OF FEES

NAME (FAMILY, GIVEN, MIDDLE) If a married woman, encircle maiden name

(Please refer to the assessment form/advisory)

UNITS Program

Major

Learning /TestingCenter

Tuition Fee
Miscellaneous Fee

Semester/School Year: _____SEM AY 20______ - 20_______

Citizenship:
Birthdate:
Sex:
Male
Female Civil Status:

Instructional Materials

Type:

ID Fee (for new students)

Continuing

New

Rejoining

Nondegree

Cross Enrollee

"In consideration of my admission to the University of the Philippines

TOTAL NO. OF UNITS

Entrance (for new students)

Deposit (for new students)
Registration Fee

Open University and of the privileges of a student in this institution. I

Library Fee

hereby promise and pledge to abide by and comply with all the rules and

Laboratory

regulations laid down by competent authority in the University and in the

EDF (For foreign students)

college or school in which I am enrolled."

____________________________
______________
Signature of Student
Date
For any change in contact/student information,
please fill-up the Request for Change in Info Form

Other Fees

OFFICE ADDRESS:

TOTAL FEES
AMOUNT PAYABLE
(Amount paid for tuition and other fees)

Office/Institution:______________________________________________________________
Occupation:________________________

Office Category: __Government

___Private

Address:____________________________________________________________________
____________________________________________ Tel no.::________________________
Email:______________________________________

Fax no.:________________________

__________

____________ _____________

PAID THRU

REF/OR #

AMOUNT

SCHOLARSHIP________________________

Checked by:

Assessed by:

_________________

_________________

This serves as your registration form.

HOME ADDRESS:
Address:____________________________________________________________________

Email or send through fax together

____________________________________________ Tel no.::________________________

with the proof of payment to your Coordinator

Email:______________________________________

For the contact information of your Coordinator,

PREFERRED MAILING ADDRESS:

HOME

Fax no.:________________________
OFFICE

please visit www.upou.edu.ph

------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

DEAN'S
DEAN'S
REGISTRAR'S
DEAN'S

UPOU FORM 5 UNIVERSITY OF THE PHILIPPINES OPEN UNIVERSITY CERTIFICATE OF REGISTRATION (Rev July 2010)
WRITE IN BLOCK LETTERS. Use an X in answering information preceded by a box.
PLEASE WRITE LEGIBLY
STUDENT NUMBER

COURSE/S

COPY

ASSESSMENT OF FEES

NAME (FAMILY, GIVEN, MIDDLE) If a married woman, encircle maiden name

(Please refer to the assessment form/advisory)

UNITS Program

Major

Learning /TestingCenter

Tuition Fee
Miscellaneous Fee

Semester/School Year: _____SEM AY 20______ - 20_______

Citizenship:
Birthdate:
Sex:
Male
Female Civil Status:

Instructional Materials

Type:

ID Fee (for new students)

Continuing

New

Rejoining

Nondegree

Cross Enrollee

"In consideration of my admission to the University of the Philippines

TOTAL NO. OF UNITS

Entrance (for new students)

Deposit (for new students)
Registration Fee

Open University and of the privileges of a student in this institution. I

Library Fee

hereby promise and pledge to abide by and comply with all the rules and

Laboratory

regulations laid down by competent authority in the University and in the

EDF (For foreign students)

college or school in which I am enrolled."

____________________________
______________
Signature of Student
Date
For any change in contact/student information,
please fill-up the Request for Change in Info Form

Other Fees

OFFICE ADDRESS:

(Amount paid for tuition and other fees)

Office/Institution:______________________________________________________________
Occupation:________________________

TOTAL FEES
AMOUNT PAYABLE

Office Category: __Government

___Private

Address:____________________________________________________________________
____________________________________________ Tel no.::________________________
Email:______________________________________

Fax no.:________________________

__________
PAID THRU

____________ _____________
REF/OR #

AMOUNT

SCHOLARSHIP________________________

Checked by:

Assessed by:

_________________

_________________

This serves as your registration form.

HOME ADDRESS:
Address:____________________________________________________________________

Email or send through fax together

____________________________________________ Tel no.::________________________

with the proof of payment to your Coordinator

Email:______________________________________

For the contact information of your Coordinator,

PREFERRED MAILING ADDRESS:

HOME

Fax no.:________________________
OFFICE

please visit www.upou.edu.ph

STUDENT'S

UPOU FORM 5 UNIVERSITY OF THE PHILIPPINES OPEN UNIVERSITY CERTIFICATE OF REGISTRATION (Rev July 2010)
WRITE IN BLOCK LETTERS. Use an X in answering information preceded by a box.
PLEASE WRITE LEGIBLY
STUDENT NUMBER

ASSESSMENT OF FEES

NAME (FAMILY, GIVEN, MIDDLE) If a married woman, encircle maiden name

STUDENT'S
COPY

(Please refer to the assessment form/advisory)

COURSE/S

UNITS Program

Major

Learning /TestingCenter

Tuition Fee
Miscellaneous Fee

Semester/School Year: _____SEM AY 20______ - 20_______

Citizenship:
Birthdate:
Sex:
Male
Female Civil Status:

Instructional Materials

Type:

ID Fee (for new students)

Continuing

New

Rejoining

Nondegree

Cross Enrollee

"In consideration of my admission to the University of the Philippines

TOTAL NO. OF UNITS

Entrance (for new students)

Deposit (for new students)
Registration Fee

Open University and of the privileges of a student in this institution. I

Library Fee

hereby promise and pledge to abide by and comply with all the rules and

Laboratory

regulations laid down by competent authority in the University and in the

EDF (For foreign students)

college or school in which I am enrolled."

____________________________
______________
Signature of Student
Date
For any change in contact/student information,
please fill-up the Request for Change in Info Form

Other Fees

Checked by:

Assessed by:

_________________

_________________

TOTAL FEES
AMOUNT PAYABLE
(Amount paid for tuition and other fees)

__________ ____________ _____________

PAID THRU
REF/OR #
AMOUNT
-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------UPOU FORM 5 UNIVERSITY OF THE PHILIPPINES OPEN UNIVERSITY CERTIFICATE OF REGISTRATION (Rev July 2010)
CASHIER'S
REGISTRAR'S
DEAN'S
WRITE IN BLOCK LETTERS. Use an X in answering information preceded by a box.
PLEASE WRITE LEGIBLY
COPY
SCHOLARSHIP____________________________

This serves as your official registration form.

STUDENT NUMBER

NAME (FAMILY, GIVEN, MIDDLE) If a married woman, encircle maiden name

COURSE/S

UNITS Program

Major

Learning /TestingCenter

ASSESSMENT OF FEES
(Please refer to the assessment form/advisory)
Tuition Fee
Miscellaneous Fee

Semester/School Year: _____SEM AY 20______ - 20_______

Citizenship:
Birthdate:
Sex:
Male
Female Civil Status:

Instructional Materials

Type:

ID Fee (for new students)

Continuing

New

Rejoining

Nondegree

Cross Enrollee

"In consideration of my admission to the University of the Philippines

Entrance (for new students)

Deposit (for new students)
Registration Fee

Open University and of the privileges of a student in this institution. I

Library Fee

hereby promise and pledge to abide by and comply with all the rules and

Laboratory

regulations laid down by competent authority in the University and in the

EDF (For foreign students)

college or school in which I am enrolled."

____________________________
______________
Signature of Student
Date
For any change in contact/student information,
please fill-up the Request for Change in Info Form
Assessed by:
_________________
SCHOLARSHIP____________________________

Other Fees

TOTAL FEES
AMOUNT PAYABLE
Checked by:
(Amount paid for tuition and other fees)
_________________
__________ ____________ _____________
This serves as your official registration form.
PAID THRU
REF/OR #
AMOUNT
-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------UPOU FORM 5 UNIVERSITY OF THE PHILIPPINES OPEN UNIVERSITY CERTIFICATE OF REGISTRATION (Rev July 2010)
AUDITOR'S
COPY
WRITE IN BLOCK LETTERS. Use an X in answering information preceded by a box.
PLEASE WRITE LEGIBLY

TOTAL NO. OF UNITS

STUDENT NUMBER

NAME (FAMILY, GIVEN, MIDDLE) If a married woman, encircle maiden name

COURSE/S

UNITS Program

Major

Learning /TestingCenter

ASSESSMENT OF FEES
(Please refer to the assessment form/advisory)
Tuition Fee
Miscellaneous Fee

Semester/School Year: _____SEM AY 20______ - 20_______

Citizenship:
Birthdate:
Sex:
Male
Female Civil Status:

Instructional Materials

Type:

ID Fee (for new students)

Continuing

New

Rejoining

Nondegree

Cross Enrollee

"In consideration of my admission to the University of the Philippines

TOTAL NO. OF UNITS

Checked by:
_________________

Entrance (for new students)

Deposit (for new students)
Registration Fee

Open University and of the privileges of a student in this institution. I

Library Fee

hereby promise and pledge to abide by and comply with all the rules and

Laboratory

regulations laid down by competent authority in the University and in the

EDF (For foreign students)

college or school in which I am enrolled."

____________________________
______________
Signature of Student
Date
For any change in contact/student information,
please fill-up the Request for Change in Info Form
Assessed by:
_________________
SCHOLARSHIP____________________________

This serves as your official registration form.

Other Fees

TOTAL FEES
AMOUNT PAYABLE
(Amount paid for tuition and other fees)
__________ ____________ _____________
PAID THRU
REF/OR #
AMOUNT