UPM FORM C OFFICE OF THE UNIVERSITY REGISTRAR, University ofthe Phillopines Manila (The Health Sciences Center) Paore Faura Street, Manila “Teleohone #(02)8141244,(02)8141245 Hatine #09050153914 (CLOME) 00292031640 (SMART) ‘CONFIRMATION OF DECISION TO ENROLL IN THE UNIVERSITY OF THE PHILIPPINES MANILA Instructions: Accomplish the form by filing out all the blanks and answering allthe questions then submit it tothe Office of the University Registrar, UP ‘Manila. Please write clearly and legibly i wil be downloaded and ‘accomplished by hand. ‘TAKE NOTE THAT THIS FORM MUST BE RECEIVED BY THE OFFICE OF THE UNIVERSITY REGISTRAR, UP MANILA ON OR BEFORE 20 JULY 220 FAILURE ‘TO SUBMIT WOULD MEAN THAT YOUR SLOT WILL BE OFFERED TO WAITLISTED APPLICANTS, Name_AUANNE ViCTORIA ¢. PLETE ‘Student Number 2020 -_12074 A. Successful Applicants (those with assigned courses tocencol in the University ofthe Philippines Mania? Yes, intend to enrellin UP Mania nthe degree program | qualified 15 No, Ido notintend to ervelin UP Manila because Do you intend B. Successful Applicants who will defer enroliment during AY 2020-2021 | will defer my enrolment and enroll curing the Sernester 202___(i dus to health reason, submit mecical carieatey C. Applicants with course code 7777 or DPWS (Degree Programs with Available Slots) Identity 2 BS degree courses in order of your preference and choose at least 2 from eny ofthe folowing dagroe programe. Number your choices according ‘to your preference. Assignmentto a degree program will depend on availabilty (of slots and UP. [BA Patt Soese | BA Oranizatona! Communeaica BA Socal ScenesQUALIFIERS WITH DPWS STATUS MAY INQUIRE STARTING 25 JULY 2020 REGARDING THEIR COURSE ASSIGNMENTS AND WILL BE INSTRUCTED TO ‘CONFIRM ENROLLMENT TO UP MANILA. D. Retum Service Agreement (RSA) Ityou intend to enrol in any ofthe courses offered by the folowing collages — Aled Medical Professions, Public Health, Nursing, Pharmacy, Denistiy and Medicine (Intarmed), please read caretily the attached article on Return Service Agreement (RSA). E, Advanced Placement Examination (APE) ‘Advanced Placement Examinations are temporaniy suspended due to the current station. Intention to apply for nancial assistance uncer the Socialized Tulton System (STS) ‘YES, intend to apply. Pease read careful the STS irairucons © 'No, 1donotintend to appy, RUNNE VICTORIA ¢. BLETE Agu conngllA R._pUsrE ‘Signature over Printed Name of Signature over Printed Narre of ‘StudentDate ParentGuardavOate Res. Tol No,_(013) sal e751 Res. Tel, Nos con) 796-tut Colphone # GESTS Cellphone #_ounsmngpD Home Adgress; Home AdGress 26 PaneANiBan 6F, POAC 3, robohe AG Pawcausoan ch, remain, MAAN Ay, TATRA 4332 re, men ER Email Address: nomonctoiapOyroi.an Email Address;_OotpweR Wa tst 9p