Ateneo de Davao University Office of Admission and Aid
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FORM 20FS ADDU (04-2014) Previous Edition Obsolete Application for Admission to Foreign Students 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 Zip Code Zip Code Email Address Position in the Family No. of Sisters PARENTS Father Mother Parents as listed above Legal Guardians Name: _____________________ Agency: __________________________ FORM 20FS (ADDU 04-2014) Page 1 Ateneo de Davao University Office of Admission and Aid No. of Brothers Telephone No(s). Family Background Name as it appears on the Birth Certificate Course(s) Applied for in order of preference Last Name First Name Contact Information PERMANENT ADDRESS CITY ADDRESS House No. Street Subdivision/Sitio 1 2 3 Basic Personal Information Birthdate Birthplace Gender Civil Satus Citizenship Religion Middle Name Province/Country Barangay City/Municipality Province/Country Telephone No(s). Name Parent's Marital Status Name of Spouse (if married) Mobile No. House No. Street Subdivision/Sitio Barangay City/Municipality Occupation Living Contact No. In Case of Emergency (if boarding or living with relative, indicate name of landlady of guardian as person to contact) Person to Contact Telephone No. Relationship Mobile No. PLEASE DO NOT WRITE BELOW THIS LINE Application Fee Paid (DBC Admissions) OR No. ____________________ Amount: ___________________ Date: __________ Code Regular Conditional Remarks Section 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 educational records and information to your parents, legal guardians, and specific agency: Recent 1x1 Photo of Applicant
Transcript of Ateneo de Davao University Office of Admission and Aid
FORM20FS
ADDU(04-2014)PreviousEditionObsolete
Application for Admission to Foreign Students
Instructions:
1. Filloutthisformcarefullyandprint(inBLOCKletters)ortypeallinformationrequested.
2. Submitallrequirementsalongwiththisform.
3. Onlyapplicationformsproperlyaccomplishedandsubmittedwiththecompleterequirementswillbeprocessed.
4. Onlyapplicationformswithoriginalsignaturesoftheapplicantandtheparents.guardianwillbeprocessed
Suffix
ZipCode ZipCode
EmailAddress
PositionintheFamily No.ofSistersPARENTSFatherMother
Parentsaslistedabove LegalGuardiansName: _____________________ Agency:__________________________
FORM20FS(ADDU04-2014)
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Ateneo de Davao University Office of Admission and Aid
No.ofBrothers
TelephoneNo(s).
FamilyBackground
NameasitappearsontheBirthCertificate Course(s)Appliedforinorderofpreference
LastNameFirstName
ContactInformation
PERMANENTADDRESS CITYADDRESSHouseNo.StreetSubdivision/Sitio
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BasicPersonalInformation
BirthdateBirthplaceGender
CivilSatusCitizenshipReligion
MiddleName
Province/Country
BarangayCity/MunicipalityProvince/CountryTelephoneNo(s).
Name
Parent'sMaritalStatusNameofSpouse(ifmarried)
MobileNo.
HouseNo.StreetSubdivision/SitioBarangayCity/Municipality
Occupation Living ContactNo.
InCaseofEmergency(ifboardingorlivingwithrelative,indicatenameoflandladyofguardianaspersontocontact)PersontoContactTelephoneNo.
RelationshipMobileNo.
PLEASEDONOTWRITEBELOWTHISLINEApplicationFeePaid(DBCAdmissions)ORNo.____________________Amount:___________________Date:___________________Cashier: __________________
CodeRegular Conditional Remarks
Section
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.PleasechecktheboxesbelowtoindicateyourconsentfortheUniversitytodiscloseeducationalrecordsandinformationtoyourparents,legalguardians,andspecificagency:
Recent1x1
PhotoofApplicant
FORM20FS
ADDU(04-2014)
PreviousEditionObsolete
HEALTH/MEDICALPROFILE
Ifyes,pleaseindicate:
FORM20FS[ADDU04-2014]
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DATESIGNED
PARENT'S/GUARDIAN'SNAMEANDSIGNATURE
IMPORTANT:CredentialsfiledinsupportofthisapplicationbecomethepropertyoftheAteneodeDavaoUniversityandwillnotbereturnedtotheapplicant.Misrepresentationofinformationrequestedinthisapplicationwillbesufficientreasonforrefusalofadmissionandexclusion.
APPLICANT'SUNDERTAKING
Iherebycertifythatallinformationwritteninthisapplicationiscompleteandaccurate.Ifacceptedasastudent,Iagreethatmyadmission,registration,andgraduationaresubjecttotherulesandregulationsoftheAteneodeDavaoUniversity.
APPLICANT'SSIGNATURE
The500-wordessayshouldbeonepagelong,handwrittenonalongbondpaper(page3ofthisform).Topicsselectedatrandomwillbegiventotheapplicantassoonastheapplicationformisfilledout.Theessaymustbewrittenbytheapplicantunassisted.Noparentorguardianisallowedinsidetheessay-writingandinterviewareas.
Preferenceofparent/guardianinreceivingGradeReportCard(selectone)PleasesendthruemailIndicateEmailaddressbelow
PleasesendthrupostalmailIndicateParent/Guardian'sBillingAddressbelow
Brieflydescribeyourreasonforseekinghelp:
PERSONALESSAY
Areyoucurrentlyintherapy,rehabilitaion,orclinicalcounselingelsewhere?Ifyes,withwhom: ContactInformation
Listanyhealthproblemsforwhichyouarecurrentlyreceivingtreatment:
DoyouallowtheUniversityIntegratedHealthServicestoconferwithyourphysicianregardingyourcondition?PSYCHOLOGICALPROFILE
Physician'sContactInformation
HighSchool
AdditionalInformationforHighSchoolPrincipal'sName
EDUCATIONALBACKGROUND
PrimaryGradeSchool
NameofSchool Address YearsAttended
ContactNumbersGuidanceCounselor'sName
AwardsReceivedinHighSchool--AcademicHonors,SpecialAwards,ifany.(pleaseindicatetheawardsreceived,theawardinginstitutionanddate)
BloodGroup
Family/PersonalPhysician'sName
Presentlytakingmedication?
Rh
FORM20FS
ADDU(04-2014)
PreviousEditionObsolete
LEGALNAME:(NameinBirthCertificate) LastName FirstName MiddleName
ESSAYCODE:_____________ START:______________ END:________________
Date:
InitialObservation:
FORM20[ADDU03-2015]
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NameofInterviewer/Evaluator: Program/Department/School
CLASSIFIEDRECORDS
PERSONALESSAY
Ifonprobation/waitlisted,numberofunitsallowedtobeenrolled:____CoursestobeexcludedintheRegistrationFormthiscomingsemester
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