OFFICE OF ADMISSIONS, UNIVERSITY OF THE PHILIPPINES

Kalaw Corner Quirino Streets UP Diliman, Quezon City 1101 Philippines

Telefax: +632 927-4561 Telephone: +632 981-8500 loc. 3287/3828/3830/3831
E-mail: upcatapplications@up.edu.ph Website: https://upcat.up.edu.ph/

REQUEST TO REVISE UPCAT 2020 APPLICATION FORM

You can submit this form together with Forms 1 and 2, or submit separately. You can submit in
person, thru an authorized representative (must bring authorization letter and an ID), or by
courier service. (The request should be addressed to the Director of the UP Office of
Admissions, using the mailing address shown above)
Deadline for submission of the request is on August 30, 2019.

I would like to request the following change(s) in my UPCAT application Form 1:

(Only the following can be revised in your UPCAT application form)

CHOICE OF CAMPUS
NO CHANGES

INTENDED COURSE IN 1ST CHOICE CAMPUS (UP CEBU)

NO CHANGES

INTENDED COURSE IN 2ND CHOICE CAMPUS (UP VISAYAS - TACLOBAN COLLEGE)

NO CHANGES

TEST CENTER

Naval, PROVINCE OF BILIRAN [0801]

REASON FOR REQUEST IN CHANGE OF TEST CENTER:

O'm currently residing in Caibiran, Biliran and Naval, Biliran is nearest testing center to me.
Approval of request will depend on availability of test permits for the requested test center

JEANETH DIAN MALAZARTE MASBANG

Name and Signature of Applicant

Date of Request: Aug 03, 2019

Application No. 1202948447

120-294-8447 08/03/2019 10:57 AM

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