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
123
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
