School of Library and Information Studies

University of the Philippines Diliman

3rd floor Gonzalez Hall, UP Diliman, Q.C.
Attach picture here
Tel.: 981-8500 local 2869, 2870, 2871
2 x 2 or
Application for Admission to the Bachelor of Library and passport size
Information Science (BLIS) (1st / 2nd) Sem, AY 2017 - 2018

Name: ______________________________ _______________________________ _________________________

Last First Middle
Student Number: _________________ Sex: ______ Date of Birth: ______________ Place of Birth: _______________
Civil Status: __________ If married, name of spouse _______________________________ Religion: _______________________

Present Mailing Address: ____________________________________________________________________________________

_________________________________________________________________ Landline No.: __________________________
Permanent Mailing Address: _________________________________________________________________________________
________________________________________________________________ Landline No.: _________________________
Mobile No.: ___________________________________ Email Address: _____________________________________
Educational Background

First enrollment: UP College _____________________________________ (___ Sem ___) Degree Pursued: _________________

Last enrollment: UP College _____________________________________ (___ Sem ___) Degree Pursued: _________________

Family Background
Father’s name: ______________________________________________________ Occupation: ___________________________
Address: ___________________________________________________________ Mobile/Landline No.: ____________________

Mother’s name: _____________________________________________________ Occupation: ____________________________

Address: ___________________________________________________________ Mobile/Landline No.: _____________________

Guardian’s name: ____________________________________________________ Occupation: ____________________________

Address: ____________________________________________________________Mobile/Landline No.: ____________________
References:
Academic Name: _______________________________________________________ Position: __________________________
Address: _____________________________________________________ Mobile/Landline No.: _______________

Character Name: _______________________________________________________ Position: _________________________

Address: _____________________________________________________ Mobile/Landline No.: _______________

Give your reasons as to why you want to apply in the BLIS program. Handwritten please. Use additional paper, if necessary.

(Please do not leave any blank unanswered)

I hereby certify that all the information given above are complete and accurate. I know that any false or misleading
information given above can mean ineligible for admission or subject to dismissal. If admitted, I agree to abide by the policies, rules
and regulations of the University.

_________________________ _________________________
Signature Date

26 Oct 2016