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Transcript of ^íÉåÉç=ÇÉ=a~î~ç=råáîÉêëáíó FORM 20DUAL Office of …It is the policy of the Ateneo...
FORM20DUALADDU(03-2014)
PreviousEditionObsolete
Office of Admission and Aid ^ééäáÅ~íáçå=Ñçê=^Çãáëëáçå=Ñçê=aì~ä=`áíáòÉå
Instructions:1. Filloutthisformcarefullyandprint(inBLOCKletters)ortypeallinformationrequested.2.Submitallrequirementsalongwiththisform.3. Onlyapplicationformsproperlyaccomplishedandsubmittedwiththecompleterequirementswillbeprocessed.4.Onlyapplicationformswithoriginalsignaturesoftheapplicantandtheparents.guardianwillbeprocessed
Suffix
CivilSatus
Religion
ZipCode ZipCode
EmailAddress
PositionintheFamily
PARENTS
Father
Mother
Parentsaslistedabove LegalGuardiansName: ___________________________ Agency:_________________________
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ItisthepolicyoftheAteneodeDavaoUniversity,inaccordancewiththeManualofRegulationsforPrivateHigherEducation2008(MORPHE)andtheEducationActof1982,towithholddisclosureofpersonallyidentifiableinformationfromeducationalrecordsunlessthestudenthasconsentedtodisclosureorthelawallowssuchdisclosure.
Bycheckingtheboxesbelow,yougiveconsenttodiscloseyoureducationrecordstoyourparents,legalguardians,andotherdesignedagenciesorgrantinstitutionyouspecify.ThepurposeoftheconsentistoallowtheUniversitytoreleasetheeducationalrecords,awardsandstudentinformation.Thisconsentwillremainonyourrecords.Suchinformationincludesdegrees,grades,courseschedules,disciplinaryrecords,awardsandstudentinformation.ThisconsentwilremainonyourrecordsandallowtheUniversitytoreleaseinformationtoyourparents,legalguardians,andagenciesspecified,evenwhenyouarenolongerlistedasadependentonyourparent'sincometaxreturn,oryouhavegraduatedandlefttheUniversity,unlessyourevokethispermissionbynotifyingtheRegistrar'sOfficeinwritingyourintenttodoso.PleasechecktheboxesbelowtoindicateyourconsentfortheUniversitytodisclose
PLEASEDONOTWRITEBELOWTHISLINE
ApplicationFeePaid(DBCAdmissions)ORNo.________________Amount:________________Date:__________________Cashier:__________________
CodeRegular Conditional Remarks
Section
TelephoneNo. MobileNo.
Parent'sMaritalStatus
NameofSpouse(ifmarried)
InCaseofEmergency(ifboardingorlivingwithrelative,indicatenameoflandladyofguardianaspersontocontact)
PersontoContact Relationship
FamilyBackground
No.ofBrothers
Occupation Living ContactNo.Name
No.ofSisters
TelephoneNo(s). TelephoneNo(s).
MobileNo.
City/Municipality City/Municipality
Province/Country Province/Country
Subdivision/Sitio Subdivision/Sitio
Barangay Barangay
HouseNo. HouseNo.
Street Street
^íÉåÉç=ÇÉ=a~î~ç=råáîÉêëáíó
Gender
ContactInformation
PERMANENTADDRESS CITYADDRESS
BasicPersonalInformation
Birthdate
Birthplace Citizenship
FirstName 2
MiddleName 3
NameasitappearsontheBirthCertificate Course(s)Appliedforinorderofpreference
LastName 1
Recent1x1
PhotoofApplicant
FORM20DUALADDU(03-2014)
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HEALTH/MEDICALPROFILE
Ifyes,pleaseindicate:
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DATESIGNED
IMPORTANT:CredentialsfiledinsupportofthisapplicationbecomethepropertyoftheAteneodeDavaoUniversityandwillnotbereturnedtotheapplicant.Misrepresentationofinformationrequestedinthisapplicationwillbesufficientreasonforrefusalofadmissionandexclusion.
IndicateEmailaddressbelow IndicateParent/Guardian'sBillingAddressbelow
APPLICANT'SUNDERTAKING
Iherebycertifythatallinformationwritteninthisapplicationiscompleteandaccurate.Ifacceptedasastudent,Iagreethatmyadmission,registration,andgraduationaresubjecttotherulesandregulationsoftheAteneodeDavaoUniversity.
APPLICANT'SSIGNATURE PARENT'S/GUARDIAN'SNAMEANDSIGNATURE
Pleasesendthruemail Pleasesendthrupostalmail
Ifyes,withwhom: ContactInformation
Brieflydescribeyourreasonforseekinghelp:
PERSONALESSAY
The500-wordessayshouldbeonepagelong,handwrittenonalongbondpaper(page3ofthisform).Topicsselectedatrandomwillbegiventotheapplicantassoonastheapplicationformisfilledout.Theessaymustbewrittenbytheapplicantunassisted.Noparentorguardianisallowedinsidetheessay-writingandinterviewareas.
Preferenceofparent/guardianinreceivingGradeReportCard(selectone)
Listanyhealthproblemsforwhichyouarecurrentlyreceivingtreatment:
DoyouallowtheUniversityIntegratedHealthServicestoconferwithyourphysicianregardingyourcondition?
PSYCHOLOGICALPROFILE
Areyoucurrentlyintherapy,rehabilitaion,orclinicalcounselingelsewhere?
Family/PersonalPhysician'sName
Physician'sContactInformation
Presentlytakingmedication?
AwardsReceivedinHighSchool--AcademicHonors,SpecialAwards,ifany.(pleaseindicatetheawardsreceived,theawardinginstitutionanddate)
BloodGroup Rh
ContactNumbers
GradeSchool
HighSchool
AdditionalInformationforHighSchool
Principal'sName GuidanceCounselor'sName
Primary
EDUCATIONALBACKGROUND
NameofSchool Address YearsAttended
FORM20DUALADDU(04-2014)
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LEGALNAME:
(NameinBirthCertificate) LastName FirstName MiddleName
ESSAYCODE:_____________ START:______________ END:________________
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CLASSIFIEDRECORDS
PERSONALESSAY