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 UNITSProgram 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 UNITSProgram 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 name STUDENT 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'S REGISTRAR'S
COPY
DEAN'S REGISTRAR'S
DEAN'S DEAN'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 UNITSProgram 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 UNITSProgram 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 UNITSProgram 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'S
CASHIER'S
COPY
AUDITOR'S
COPY