✔ I have read and fully understood the provisions contained in the Code of Conduct and Discipline of the

University of Santo Tomas and promise to abide by the requirements and policies set forth therein and
those which may thereafter be promulgated by the University.

✔ I understand that in the first academic year of my stay in the University, I shall submit myself to
mandatory drug testing to be facilitated by the University Health Service. In the succeeding years of
my stay, I shall submit myself to random drug testing in conformity with the Drug Free Policy of the
University and as required by R.A. 9165 (Comprehensive Dangerous Drugs Act of 2002).

✔ I am not a member and will not form, join or participate in any unrecognized organization or
organization whose purpose is contrary to the mission and vision of the University of Santo Tomas or
whose purpose is contrary to law or an organization which was formed to move or incite its members
to the commission of crime or adopt means contrary to the peaceful manner of solving problem. I
understand that in the event that I become a member of any of the above-mentioned organization, I
shall face the sanction of exclusion (dropping from the roll of qualified students).

✔ I undertake to contribute to the maintenance of peace and order in the University. I commit myself to
anti-hazing in any form or manner and I shall not employ or subject myself to it. I will promptly report
to the security force or authorities any act in violation thereof.

✔ I understand that this declaration is binding and effective from my admission until my
transfer/graduation credentials are issued by the University.

CONFORME:

I attest that I have carefully read, fully understood, and willingly commit to the policies,
guidelines and regulations stipulated in the Conforme for Enrollment of the University of Santo
Tomas.

PATRICIA ANNE CALILUNG ZITA Student Number : 2015083752________________________

SIGNATURE OVER PRINTED NAME OF STUDENT
Date : 07/30/2019_____________________________________
Faculty/College/School/Institute : Contact Number : __________________________________________
FACULTY OF ARTS AND LETTERS___________________
Attested:

SIGNATURE OVER PRINTED NAME OF PARENT/GUARDIAN

Date : _________________________________________________________

INSTRUCTIONS : Kindy print and submit this form to the Office of the Dean

UST:S030-00-FO98b