CONTRACT OF CONFORMITY WITH THE UNIVERSITY RULES

Note: Kindly submit your duly accomplished CCUR Form at the OSA-Student Discipline Section

I,_____________________________________________________________________________
(Surname Given Name Middle Name)
(NATIONALITY)_______________________,with Degree Program ________________________________ and ID
No. ____________________________, from the College of ________________________, born on
_________________________(Date of Birth) and with residence and postal address at
___________________________________________________________________with the contact number
_______________from_____________________________________(Last School Attended)), after having been
duly sworn to in accordance with the University’s rules and regulations, hereby depose and state that: (
Depending on your answer, affix your signature on either question number 1 or 2, AND at the end of question
number 18 of this CCUR)

1.Are you a member of any fraternity, sorority, or any organization similar to fraternities or sororities?
1.1 If YES, what is the name of your fraternity /sorority or organization?
_________________________________________________________________________

1.2 Is your fraternity /sorority/or organization (Mark with X)

School-based or Community-based
1.3 State the chapter/location/address of your fraternity /sorority or
organization_______________________________________________________.

1.4 I pledge, I shall not, during the duration of my entire stay at the University, participate or be involved
in fraternity/sorority-related activities such as but not limited to the promotion of any
fraternity/sorority, recruitment of members, initiation or welcoming rites, or hazing defined under
the Anti-Hazing Act of 2018 or R. A. No. 11053 which is punishable by dismissal or expulsion.

Signature over Printed Name Parent/Guardian Signature over Printed Name

Date:__________________ Date:___________________

2. If NO (referring to question under Section Number 1)

2.1 I pledge, I shall not, during the duration of my entire stay at the University, join or be a
member or supporter of any subversive or illegal associations, nor of any organization not
recognized by the University, especially fraternities and sororities, or be involved in their
activities such as but not limited to the promotion of any fraternity/sorority, recruitment of
members, initiation or welcoming rites, or hazing defined under the Anti-Hazing Act of 2018 or
R.A. No. 11053 which is punishable by dismissal or expulsion.

Signature over Printed Name Parent/Guardian Signature over Printed Name

Date:__________________ Date:___________________

CONFORMITY WITH OTHER UNIVERSITY RULES

Furthermore, I pledge that:

3. I shall behave and conduct myself properly befitting as an Adamsonian whether inside or
outside the University;
4. I shall not commit vandalism, destroy or deface any school property;
5. I shall never be under the influence of any dangerous and prohibited drugs, and alcoholic drinks while on the
University premises;
6. I shall not carry any deadly or dangerous weapon or explosives or prohibited items;
7. I shall not read or carry pornographic material or access pornographic sites on campus;
8. I shall not participate directly or indirectly in any illegal assembly, barricade, boycott, or
rally that tends to disrupt classes or school activities;
9. I shall abide by all academic, and other policies of the University and the Code of Student
Conduct and Discipline stated in the Student Manual;
10. I shall uphold the vision-mission and core values of the University, obey all the rules and
regulations of the University as well as the laws of the country;
11. I shall not engage in any activity that undermines the respect and dignity of other persons,
students, faculty, non-teaching personnel, administrators, or the good name or
the reputation of the school which under the rules is a ground for serious misconduct;
12. I shall obligate myself to read the contents of the Student Manual and its supplementary
codes, policies, and rules and be familiarized with its provisions found in hard copy and
electronic copy accessible at the Learning Management System (LMS);
13. I fully understand and accept that my admission to the University is a privilege and not a right and that the
University has the right and authority to determine and decide who will be admitted as a student of the
University;
14 I fully understand and accept that the University has the authority to prescribe rules and regulations
governing membership of students in any fraternity, sorority, organization, or association, whether within
or outside the University, consistent too its right to establish disciplinary rules and regulations.
15. I fully understand and accept that my continued stay in the UNIVERSITY is subject to my compliance with
prescribed discipline policies, rules, and regulations, especially with regard to fraternities, sororities, or
similar organizations as defined under the Anti-Hazing Act of 2018 or R.A. No. 11053.
16. I fully understand and accept that the UNIVERSITY can:
16.1 invite me for a random interview regarding the CCUR or for any incident related to fraternity
sorority, or any unrecognized organization in which my name may be allegedly implicated; and
16.2 either dismiss or expel me if I would be found having violated the conditions of this affidavit as
well as having falsely certified any information stated herein
17. I fully understand that the information and data contained herein are confidential;
18. I am giving my consent to the OSA-Student Discipline to utilize the information I provided herewith for
academic and/or administrative purposes.
I have read and fully understand the contents and the consequences of this Contract of Conformity
with the University Rules and I am executing and submitting this affidavit as a prerequisite to my admission as
a student of the University.

______________________________ ___________________________________
College & Program/Student Number Signature over Printed Name/Date Signed

___________________________________________________
Parent/Guardian Signature over Printed Name/Date Signed

Subscribed and sworn to before me, a notary public for the City of Manila this__________ day
of_________.20______.
Doc. No. _________
Page No. _________
Book No._________
Series of _________

F-OSA-304 Rev. 4 (05-01-23)