UPOU FORM 5 UNIVERSITY OF THE PHILIPPINES OPEN UNIVERSITY CERTIFICATE OF REGISTRATION (Rev July 2010)

WRITE IN BLOCK LETTERS. Use an X in answering information preceded by a box. PLEASE WRITE LEGIBLY

-

COURSE/S UNITS Program Major Learning /TestingCenter Tuition Fee

Miscellaneous Fee

Semester/School Year: _____SEM AY 20______ - 20_______ Instructional Materials

Citizenship: Birthdate: Entrance (for new students)

Sex: Male Female Civil Status: Deposit (for new students)

Type: Continuing New Rejoining Nondegree Cross Enrollee ID Fee (for new students)

"In consideration of my admission to the University of the Philippines Registration Fee

Open University and of the privileges of a student in this institution. I Library Fee

hereby promise and pledge to abide by and comply with all the rules and Laboratory

regulations laid down by competent authority in the University and in the EDF (For foreign students)

college or school in which I am enrolled." Other Fees

____________________________ ______________

For any change in contact/student information, TOTAL FEES

please fill-up the Request for Change in Info Form AMOUNT PAYABLE

OFFICE ADDRESS: (Amount paid for tuition and other fees)

Office/Institution:______________________________________________________________ __________ ____________ _____________

Occupation:________________________ Office Category: __Government ___Private PAID THRU REF/OR # AMOUNT

Address:____________________________________________________________________

____________________________________________ Tel no.::________________________

Email:______________________________________ Fax no.:________________________ Checked by: Assessed by:

_________________ _________________

HOME ADDRESS:

Address:____________________________________________________________________

____________________________________________ Tel no.::________________________

Email:______________________________________ Fax no.:________________________

PREFERRED MAILING ADDRESS: HOME OFFICE

------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

UPOU FORM 5 UNIVERSITY OF THE PHILIPPINES OPEN UNIVERSITY CERTIFICATE OF REGISTRATION (Rev July 2010)

WRITE IN BLOCK LETTERS. Use an X in answering information preceded by a box. PLEASE WRITE LEGIBLY

-

COURSE/S UNITS Program Major Learning /TestingCenter Tuition Fee

Miscellaneous Fee

Semester/School Year: _____SEM AY 20______ - 20_______ Instructional Materials

Citizenship: Birthdate: Entrance (for new students)

Sex: Male Female Civil Status: Deposit (for new students)

Type: Continuing New Rejoining Nondegree Cross Enrollee ID Fee (for new students)

"In consideration of my admission to the University of the Philippines Registration Fee

Open University and of the privileges of a student in this institution. I Library Fee

hereby promise and pledge to abide by and comply with all the rules and Laboratory

regulations laid down by competent authority in the University and in the EDF (For foreign students)

college or school in which I am enrolled." Other Fees

____________________________ ______________

For any change in contact/student information, TOTAL FEES

please fill-up the Request for Change in Info Form AMOUNT PAYABLE

OFFICE ADDRESS: (Amount paid for tuition and other fees)

Office/Institution:______________________________________________________________ __________ ____________ _____________

Occupation:________________________ Office Category: __Government ___Private PAID THRU REF/OR # AMOUNT

Address:____________________________________________________________________

____________________________________________ Tel no.::________________________

Email:______________________________________ Fax no.:________________________ Checked by: Assessed by:

_________________ _________________

HOME ADDRESS:

Address:____________________________________________________________________

____________________________________________ Tel no.::________________________

Email:______________________________________ Fax no.:________________________

PREFERRED MAILING ADDRESS: HOME OFFICE

TOTAL NO. OF UNITS

STUDENT NUMBER NAME (FAMILY, GIVEN, MIDDLE) If a married woman, encircle maiden name

SCHOLARSHIP________________________

ASSESSMENT OF FEES

(Please refer to the assessment form/advisory)

please visit www.upou.edu.ph

please visit www.upou.edu.ph

Signature of Student Date

NAME (FAMILY, GIVEN, MIDDLE) If a married woman, encircle maiden nameSTUDENT NUMBER

TOTAL NO. OF UNITS

Signature of Student Date

SCHOLARSHIP________________________

For the contact information of your Coordinator,

ASSESSMENT OF FEES

(Please refer to the assessment form/advisory)

For the contact information of your Coordinator,

This serves as your registration form.

Email or send through fax together

with the proof of payment to your Coordinator

This serves as your registration form.

Email or send through fax together

with the proof of payment to your Coordinator

DEAN'SREGISTRAR'S COPY

DEAN'S REGISTRAR'S DEAN'SDEAN'S COPY

STUDENT'S

UPOU FORM 5 UNIVERSITY OF THE PHILIPPINES OPEN UNIVERSITY CERTIFICATE OF REGISTRATION (Rev July 2010)

WRITE IN BLOCK LETTERS. Use an X in answering information preceded by a box. PLEASE WRITE LEGIBLY

-

COURSE/S UNITS Program Major Learning /TestingCenter Tuition Fee

Miscellaneous Fee

Semester/School Year: _____SEM AY 20______ - 20_______ Instructional Materials

Citizenship: Birthdate: Entrance (for new students)

Sex: Male Female Civil Status: Deposit (for new students)

Type: Continuing New Rejoining Nondegree Cross Enrollee ID Fee (for new students)

"In consideration of my admission to the University of the Philippines Registration Fee

Open University and of the privileges of a student in this institution. I Library Fee

hereby promise and pledge to abide by and comply with all the rules and Laboratory

regulations laid down by competent authority in the University and in the EDF (For foreign students)

college or school in which I am enrolled." Other Fees

____________________________ ______________

For any change in contact/student information, TOTAL FEES

please fill-up the Request for Change in Info Form AMOUNT PAYABLE

Checked by: Assessed by: (Amount paid for tuition and other fees)

_________________ _________________ __________ ____________ _____________

PAID THRU REF/OR # AMOUNT

------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

UPOU FORM 5 UNIVERSITY OF THE PHILIPPINES OPEN UNIVERSITY CERTIFICATE OF REGISTRATION (Rev July 2010)

-

COURSE/S UNITS Program Major Learning /TestingCenter Tuition Fee

Miscellaneous Fee

Semester/School Year: _____SEM AY 20______ - 20_______ Instructional Materials

Citizenship: Birthdate: Entrance (for new students)

Sex: Male Female Civil Status: Deposit (for new students)

Type: Continuing New Rejoining Nondegree Cross Enrollee ID Fee (for new students)

"In consideration of my admission to the University of the Philippines Registration Fee

Open University and of the privileges of a student in this institution. I Library Fee

hereby promise and pledge to abide by and comply with all the rules and Laboratory

regulations laid down by competent authority in the University and in the EDF (For foreign students)

college or school in which I am enrolled." Other Fees

____________________________ ______________

For any change in contact/student information, TOTAL FEES

please fill-up the Request for Change in Info Form AMOUNT PAYABLE

Checked by: Assessed by: (Amount paid for tuition and other fees)

_________________ _________________ __________ ____________ _____________

PAID THRU REF/OR # AMOUNT

------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

UPOU FORM 5 UNIVERSITY OF THE PHILIPPINES OPEN UNIVERSITY CERTIFICATE OF REGISTRATION (Rev July 2010)

-

COURSE/S UNITS Program Major Learning /TestingCenter Tuition Fee

Miscellaneous Fee

Semester/School Year: _____SEM AY 20______ - 20_______ Instructional Materials

Citizenship: Birthdate: Entrance (for new students)

Sex: Male Female Civil Status: Deposit (for new students)

Type: Continuing New Rejoining Nondegree Cross Enrollee ID Fee (for new students)

"In consideration of my admission to the University of the Philippines Registration Fee

Open University and of the privileges of a student in this institution. I Library Fee

hereby promise and pledge to abide by and comply with all the rules and Laboratory

regulations laid down by competent authority in the University and in the EDF (For foreign students)

college or school in which I am enrolled." Other Fees

____________________________ ______________

For any change in contact/student information, TOTAL FEES

please fill-up the Request for Change in Info Form AMOUNT PAYABLE

Checked by: Assessed by: (Amount paid for tuition and other fees)

_________________ _________________ __________ ____________ _____________

PAID THRU REF/OR # AMOUNT

Signature of Student Date

TOTAL NO. OF UNITS

STUDENT NUMBER NAME (FAMILY, GIVEN, MIDDLE) If a married woman, encircle maiden name ASSESSMENT OF FEES

(Please refer to the assessment form/advisory)

STUDENT NUMBER NAME (FAMILY, GIVEN, MIDDLE) If a married woman, encircle maiden name ASSESSMENT OF FEES

This serves as your official registration form.

WRITE IN BLOCK LETTERS. Use an X in answering information preceded by a box. PLEASE WRITE LEGIBLY

(Please refer to the assessment form/advisory)

Signature of Student Date

TOTAL NO. OF UNITS

WRITE IN BLOCK LETTERS. Use an X in answering information preceded by a box. PLEASE WRITE LEGIBLY

SCHOLARSHIP____________________________

(Please refer to the assessment form/advisory)

Signature of Student Date

TOTAL NO. OF UNITS

SCHOLARSHIP____________________________

STUDENT NUMBER NAME (FAMILY, GIVEN, MIDDLE) If a married woman, encircle maiden name ASSESSMENT OF FEES

SCHOLARSHIP____________________________

This serves as your official registration form.

This serves as your official registration form.

STUDENT'S COPY

REGISTRAR'S DEAN'SCASHIER'S COPY

AUDITOR'S COPY