Student Code _______

OSA-Form 03 APPLICANT
APPLICATION FORM for
UEP ENTRANCE EXAMINATION ATTACH two (2) copies of
for Academic Year (AY) 2020-2021 your 2” x 2” ID PHOTO
WITH NAME TAG; close
up front facial picture
Applicant to please Type or PRINT clearly and completely; before a white background;
eyes, face and/or hair not
1st YEAR TRANSFEREE RETURNEE Part A. PERSONAL INFORMATION:
covered. Affix your
signature at the back of the
FAMILY NAME Suffix (e.g. JR, SR):
photo.
FIRST NAME

MIDDLE NAME

Age: _____ Birthdate: ____ / ____ / ____ / Birthplace: _______________________________________

mm dd yy
Sex: _______ Religious Affiliation: __________________________ NATIONALITY: ________________

If applicant is a Person with Disability (PWD), please specify the disability: ________________________________
(Person concerned must personally consult the Head of Student Affairs of UEP before applying.)
How many children are you in your family (Please check):
[ ]1 [ ] 2-3 [ ] 4-5 [ ] 6-7 [ ] more than 7
HOME ADDRESS:
House No. & Name of Street: _______________________________________________________________
District/Barangay:_________________________________________________________________________
Municipality (Town)/City: ______________________________ Province: ____________________________
Country/State/Zip Code:____________________________________________________________________
Telephone No.: _______________ Mobile No.: _________________ E-mail Address:__________________
*For applicant who already graduated from High School/College/Transferees/ALS, please answer truthfully and
accurately:
*For High School Graduate/s:
Last School Attended _____________________________________________ Average______________
Have you ever enrolled in any COLLEGE or VOCATIONAL/TECHNICAL COURSE? ( ) Yes ( ) No
If yes: What Course(s)?_______________________________________________________________
What School? _________________________________ What Semester? _______________________
*For ALS Passer/s:
Date Taken and Passed: _________________________________ Average: ______________________
Please indicate your course options according to your priority:
Course Major
1st Choice ____________________________ ________________________________
2nd Choice ____________________________ ________________________________
3rd Choice _____________________________ ________________________________

Part B. UNDERTAKING (must be accomplished by every filer):

I respectfully apply to take the UEP Entrance Examination for AY 2020-2021. I declare that all the above information
are COMPLETE, ACCURATE and TRUE. I certify that, to date, I have never violated the rules and regulations of my
school. I understand that any information I have misrepresented, concealed, or falsely given on my application is
enough basis to invalidate and cancel my application, my UEP Entrance Examination result, and my
admission/enrolment in UEP. I also promise to comply with all the guidelines, requirements and instructions on the
UEP Entrance Examination and the admission requirements and special conditionalities.

___________________________ __________________________
Applicant’s Signature Date of Application

[Attested by Parents/Guardian]

_____________________________________________________________________
(Father’s/Mother’s/Guardian’s PRINTED Name & Signature)
(Signature must be ORIGINAL and not photocopied. If your parents/guardians are not around to sign,
DO NOT let anybody else sign.)