Application For Admission: Niversity of Outheastern Hilippines Undergraduate Studies

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UNIVERSITY OF SOUTHEASTERN PHILIPPINES

< COLLEGE >


UNDERGRADUATE STUDIES
2X2
APPLICATION FOR ADMISSION PHOTO
IMPORTANT: 1. Fill in all information needed. Print or type all entries.
2. Attach a 2 x 2 colored picture on the right hand corner of this
form.
3. Submit this form, together with other required documents
outlined in the application procedure, to the College Dean.

DEGREE PROGRAM APPLIED FOR      


SEMESTER       SCHOOL YEAR      
FAMILY NAME       DATE OF BIRTH      
FIRSTNAME       PLACE OF BIRTH      
MIDDLE NAME       AGE   
GENDER MALE FEMALE RELIGION      
PERMANENT ADDRESS       CITY ADDRESS      
WITH ZIP CODE WITH ZIP CODE
PHONE NO.       PHONE NO.      
MOBILE NO.       EMAIL ADDRESS      
SURNAME / FIRST NAME / MIDDLE NAME OCCUPATION AGE
FATHER’S NAME               
MOTHER’S NAME               
Educational Background
DEGREE EARNED SCHOOL NAME ADDRESS INCLUSIVE DATES
HIGH SCHOOL                  
VOCATIONAL                  
COLLEGE                  
Extra-Curricular Activities (Participation / Affiliation)
TITLE / PROGRAM GRANTING INSTITUTION INCLUSIVE DATES AWARDS
                       
                       
                       
HOW WILL YOU FINANCE YOUR STUDIES AT USEP Self Parents / Relatives Scholarship
Name of granting institution if Scholar      

All information contained in this application is true and correct to the best of my knowledge. I understand that any
misrepresentation may be cause for denial of admission or expulsion from the university.

           
SIGNATURE OVER PRINTED NAME DATE

This form must be accompanied by the following requirements:


1. Honorable Dismissal or Transfer Credentials (Original Copy) for transferee
2. Form 137 (Report Card)
3. Three (3) pcs. 2 x 2 recent colored ID picture
4. Two (2) pcs 1 x 1 recent colored ID picture
5. Three (3) pcs. Long Brown Envelope
6. NSO-authenticated Birth Certificate
7. Certificate of Good Morall Character (Original Copy)
8. Medical Certificate from the USEP Clinic
9. Admission Slip

w w w . u s e p . e d u . p h

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