1962 JP Laurel Highway, Lipa City 4217

Tel. No. (043) 756-2491/756-2391/756-1849

756-1887 local 238, or (043) 981-3575
Fax No. (043) 756-3117
http://www.dlsl.edu.ph

Attach
2x2 picture
here

PRINT or TYPE all information and attach one 2x2 photograph above.
Submit this form together with the other requirements to the DLSL
COLLEGES Admissions Office. ONLY APPLICATIONS WITH CORRECT
AND
COMPLETE
INFORMATION/
REQUIREMENTS
WILL
BE
PROCESSED.

(AO Form # 03)

Application Number
Date of Application

Application is made as

For the
In the Course
First Choice
Second Choice
Third Choice

2nd Undergraduate
Degree Student

Freshman
Student

Transfer
Student

First Semester

Second Semester

School Year ___________

BS ___________________________ Certificate in ______________________

BS ___________________________ Certificate in ______________________
BS ___________________________ Certificate in ______________________

PERSONAL DATA
Write your full name. Leave
one box blank between two or
more names. Place one letter
in each box.

LAST
FIRST
MIDDLE

MAILING ADDRESS:
_______________________________________________________________
NUMBER & STREET
BARANGAY / SUBDIVISION
_______________________________________________________________
TOWN/ CITY
PROVINCE
POSTAL CODE
DATE OF BIRTH:

AGE:

PLACE OF BIRTH:

CITIZENSHIP:
GENDER:

IF MARRIED:
Male

LANDLINE NUMBER:
MOBILE PHONE NUMBER:
E-MAIL ADDRESS:

CIVIL STATUS:

RELIGION:

Roman Catholic

Protestant

Iglesia ni Kristo

Adventist

Others (Specify):

Female
Name of Husband / Wife:
___________________________
Occupation:
___________________________
Number of Children:
___________________________

EDUCATIONAL BACKGROUND
LEVEL

NAME & ADDRESS OF SCHOOL

YEAR
ATTENDED

HONORS/AWARDS

SEMESTER &
SCH. YEAR
ATTENDED

HONORS/AWARDS

GRADE SCHOOL
Nursery
Kinder
Prep
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
HIGH SCHOOL
Year I
Year II
Year III
Year IV
COLLEGIATE
Year
Year
Year
Year

NAME & ADDRESS OF

COLLEGE/UNIVERSITY

COURSE

I
II
III
IV

FAMILY BACKGROUND
FATHER

MOTHER

NAME
CITIZENSHIP
HOME ADDRESS
TEL. NO. / MOBILE NO.
E-MAIL ADDRESS
OCCUPATION
EMPLOYER
BUSINESS ADDRESS
TELEPHONE NUMBER/S
EDUCATIONAL ATTAINMENT
LAST SCHOOL ATTENDED
Is your father or mother an employee of DLSL?
Yes
No
If YES, who?
Father
Mother
Both
Kindly check the classification of specified parent:
Administrator
Faculty
Staff / Personnel
Is your father or mother an alumna of DLSL?
Yes
No
If YES, who?
Father
Mother
Both
Kindly indicate, ________________________________ _______________________
Level/ Degree
Year Graduated
GUARDIANS NAME (If not living with parents) _________________________________________
GUARDIANS MAILING ADDRESS:____________________________________________________
TEL NO. / MOBILE PHONE NO.(In case of Emergency):___________________________________
LIVING ARRANGEMENT
Living in:
Own house
Boarding House
Apartment
Staying with relatives
Others_______________

BROTHERS AND SISTERS (Please list from eldest to youngest)

NAME

AGE

CIVIL
STATUS

SCHOOL

COURSE

YEAR LEVEL/
YEAR
GRADUATED

Is this your first time to apply at DLSL?

Yes
No, Date of previous application___________
Reasons for applying at DLSL:
___________________________________________________
______________________________________________________________________________
Hobbies and Special Talents:
______________________________________________________________________________
Honors / Award / Distinctions Received:
_____________________________________
_____________________________________

_______________________________________
_______________________________________

Membership in School / Outside Organization:

_____________________________________
_____________________________________

_______________________________________
_______________________________________

Are you a working student?

If YES, Kindly indicate

Yes
No
Job Title: ___________________________________________
Job Description: ______________________________________
______________________________________
Company:___________________________________________
Business Address:_____________________________________
Telephone Number/s:__________________________________

Do you have other source of financial support for your education?

Yes
None
If Yes, please specify:________________________________________________________
HEALTH
Are you in good health condition?
Yes
No
If no, specify why?___________________________________________________________
Physical Disabilities / Defects:
________________________________________________________________________________
Where did you first find out about De La Salle Lipa? (Please check as many as applicable)
Career Orientation
Family
Posters

Friends

Internet

Advertisements

Others, please specify _________________________

Have you applied for scholarship in outside agency?

Yes

No

If YES, what Agency? _____________________

Freshman applicants who wish to apply for Scholarship at DLSL MUST REQUEST for an
application form at the LAMP Office, and TOGETHER with this application form, submit all
other requirements.

VERIFICATION

I certify that the information given herein is correct and complete. Falsification or
withholding of information on this form will automatically nullify my application and/or
subject me to dismissal from the college.

_________________
Date

______________________________
Applicants Signature

DO NOT FILL (For Admissions Staff Use Only)

HS GPA

ATP

REC

TOTAL

STATUS
REMARKS

V
NV
GST
EDT
ATP
RS
S
Test Results: ____ Mail
Date: _________________
____ Status Letter Date: _________________
____ NOA
Date: _________________
Reservation: OR No. _________________ Date:__________________
Date Enrolled: _________________
Degree / Certificate :_________________________________________

Remarks