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FORM 20DUAL ADDU (03-2014) Previous Edition Obsolete Office of Admission and Aid ^ééäáÅ~íáçå Ñçê ^Çãáëëáçå Ñçê aì~ä `áíáòÉå Instructions: 1. Fill out this form carefully and print (in BLOCK letters) or type all information requested. 2. Submit all requirements along with this form. 3. Only application forms properly accomplished and submitted with the complete requirements will be processed. 4. Only application forms with original signatures of the applicant and the parents.guardian will be processed Suffix Civil Satus Religion Zip Code Zip Code Email Address Position in the Family PARENTS Father Mother Parents as listed above Legal Guardians Name: ___________________________ Agency: _________________________ FORM 2DUAL (ADDU 03-2014) Page 1 It is the policy of the Ateneo de Davao University, in accordance with the Manual of Regulations for Private Higher Education 2008 (MORPHE) and the Education Act of 1982, to withhold disclosure of personally identifiable information from educational records unless the student has consented to disclosure or the law allows such disclosure. By checking the boxes below, you give consent to disclose your education records to your parents, legal guardians, and other designed agencies or grant institution you specify. The purpose of the consent is to allow the University to release the educational records, awards and student information. This consent will remain on your records. Such information includes degrees, grades, course schedules, disciplinary records, awards and student information. This consent wil remain on your records and allow the University to release information to your parents, legal guardians, and agencies specified, even when you are no longer listed as a dependent on your parent's income tax return, or you have graduated and left the University, unless you revoke this permission by notifying the Registrar's Office in writing your intent to do so. Please check the boxes below to indicate your consent for the University to disclose PLEASE DO NOT WRITE BELOW THIS LINE Application Fee Paid (DBC Admissions) OR No. ________________ Amount: ________________ Date: __________________ Cashier: __________________ Code Regular Conditional Remarks Section Telephone No. Mobile No. Parent's Marital Status Name of Spouse (if married) In Case of Emergency (if boarding or living with relative, indicate name of landlady of guardian as person to contact) Person to Contact Relationship Family Background No. of Brothers Occupation Living Contact No. Name No. of Sisters Telephone No(s). Telephone No(s). Mobile No. City/Municipality City/Municipality Province/Country Province/Country Subdivision/Sitio Subdivision/Sitio Barangay Barangay House No. House No. Street Street ^íÉåÉç ÇÉ a~î~ç råáîÉêëáíó Gender Contact Information PERMANENT ADDRESS CITY ADDRESS Basic Personal Information Birthdate Birthplace Citizenship First Name 2 Middle Name 3 Name as it appears on the Birth Certificate Course(s) Applied for in order of preference Last Name 1 Recent 1x1 Photo of Applicant
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:_________________________
FORM2DUAL(ADDU03-2014)
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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)
PreviousEditionObsolete
HEALTH/MEDICALPROFILE
Ifyes,pleaseindicate:
FORM20DUAL[ADDU03-2014]
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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)
PreviousEditionObsolete
LEGALNAME:
(NameinBirthCertificate) LastName FirstName MiddleName
ESSAYCODE:_____________ START:______________ END:________________
FORM20DUAL
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CLASSIFIEDRECORDS
PERSONALESSAY
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