Republic of the Philippines

UNIVERSITY OF EASTERN PHILIPPINES

PEDRO REBADULLA MEMORIAL CAMPUS
Catubig, Northern Samar
Web: http://uep.edu.ph; Email: uepprmcampus@gmail.com

ADMISSION COMMITTEE

Expression of Intent for Admission

Date Reference Number

Last Name
First Name
Middle Name
Home Address
Senior High School Strand
Senior High School
Senior High School Address
High School General Average /
GPA
Interview Result
To the Admission Committee
I would like to express my interest in pursuing my application in any of the following
programs offered by the University of Eastern Philippines – Pedro Rebadulla Memorial
Campus
First preference: _________________________
Second preference: _______________________
Third preference: _________________________

Name and Signature of Date:

Applicant
Name and Signature of Date:
Parent/Guardian

Important Reminders

1. This form must be completely accomplished and signed.

2. Upon completion, this form must be closed in an enveloped together with the other
Admission Documents.
3. The admission of the student to the program of choice will be subject to the final
decision of the Admission Committee, based on the academic requirements and the
availability of slots in the specific’s degree program. Submission of this is not a
guarantee of admission.
4. Confirmation of admission status will be announced thru the UEP PRMC official FB
account/page a week before the enrolment period for freshmen.

Effectivity Date: July 20, 2018 Document Code: UEP-T-03PRMC-001 Version No.: v1 Page 1 of 1
This document is a sole property of the UNIVERSITY OF EASTERN PHILIPPINES (UEP).
The original copy of this document is with the Documented Information Controller/Records Office.
Any disclosure, reproduction or use is strictly prohibited except with permission from UEP.