APPLICATION FOR ADMISSION

SILLIMAN UNIVERSITY
Attach
Dumaguete City, Philippines 6200 latest picture
2” X 2”
Please fully accomplish this form and send to the ADMISSIONS OFFICER,
Silliman University, Dumaguete City 6200, Philippines

Name:________________________________________________________________________________________
(Last) (First) (Middle name)

High School General Average: __________________________ (general admission requirement is at least 80%)
Home Address: ________________________________________ Tel No./Mobile: ______________________
Dumaguete Address: ____________________________________ Tel No./Mobile: ______________________
Date and Place of Birth: __________________________________ E-mail address: ______________________
Marital Status: _______________________________ Citizenship: _______________________________________
Religious Affiliation: ___________________________________________ Blood Type _______ Gender: _______
If foreigner, state status of admission: □ Immigrant □ Non-immigrant □ Balikbayan

Note: If foreigner, accomplish separate “Application for Study” permit with the Adviser to International Students at
the Office of Student Services located at the ground floor at the Oriental Hall.

List of schools you attended (from elementary up to college, if applicable)

Name Location Certificate/ Dates of Year
Degree Earned Attendance Graduated
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Course program you wish to earn in Silliman:( )Degree _______________________________________________
( )Certificate Course ______________________________________
Earliest date you wish to enter Silliman: ____________________________________________________________
Condition of health (check one): ( ) Excellent ( ) Good ( ) Fair
For Person with Disability(PWD), please state nature of disability:________________________________________
Indigenous Person: ( )Yes ( )No
Single/Solo Parent: ( )Yes ( )No
Who/What influenced you to study in Silliman University?
□ Parents □ Faculty/Staff □ Social Media □ Friend
□ Alumni □ Website □ TV/Radio □ School of origin
□ Invitation Letter □ Posters & Brochures □ School Campaign

Please describe below other factors: ________________________________________________________________

Father Mother

Name of parents
(as indicated in your birth certificate) :

Highest Degree Attended: :

School Attended: :
Year Graduated: :
Occupation: :
Optional: ANNUAL INCOME(for those who are applying scholarship)

Father Mother

Annual Income: ( Please check appropriate box )

 P 62,000 & below  P 62,000 & below

 P 62,100 – 101,000
 P 101,100 – 151,000
 P 151,100 – 191,000
 P 191,100 – 231,000
 P 231,100 – 271,000
 P 271,100 – 301,000
 P 301,100 – 351,000
 P 351,100 – 391,000
 P 391,100 – 431,000
 P 431,100 – 471,000
 P 471,100 – 501,000
 P 501,100 – 551,000
 P 551,100 – 591,000
 P 591,100 – 603,000
 P 603,100 – and above
 P 62,100 – 101,000
 P 101,100 – 151,000
 P 151,100 – 191,000
 P 191,100 – 231,000
 P 231,100 – 271,000
 P 271,100 – 301,000
 P 301,100 – 351,000
 P 351,100 – 391,000
 P 391,100 – 431,000
 P 431,100 – 471,000
 P 471,100 – 501,000
 P 501,100 – 551,000
 P 551,100 – 591,000
 P 591,100 – 603,000
 P 603,100 – and above

Address and Contact Number of Parents: ____________________________________________________________

Name, Address and Contact Number of Guardian : ____________________________________________________
________________________________________ ______ Occupation: ________________________________
Who is responsible for the payment of your tuition and school fees? (Name of and relationship to re-
person/sponsor.)
_____________________________________________________________________________________________
Will you live in the dormitory? If yes, what type of accommodation?
( ) Yes ( ) No ( ) Regular ( ) Cooperative
If no, where will you stay? (Specify name and address)
Name of Relative or Friend Name of Lodging House
___________________________________________ ______________________________________________
___________________________________________ ______________________________________________

The above information is true and correct. Once admitted in Silliman University, I hereby accept and abide
by the rules and regulations of the University, including the submission of myself to random drug testing.

_______________ __________________________________
Date Signature of Student Over Printed Name

FOR THE PARENT OR GUARDIAN

I, _____________________________________________ of____________________________________________
(Parent / Guardian) (Student)
hereby approve the application of my son/daughter/ward, for admission to Silliman University and hereby accept
and agree to abide by the rules and regulations of the University and consent to the random drug testing of my child
as may be provided for by the University.

_______________ __________________________________________
Date Signature of Parent or Guardian Over Printed Name