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DLSAA Card
the more we can do together to live up to the challenge given to us in becoming Christian Achievers for God and Country.
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STUDENT ID NO. BIRTHDATE (MM/DD/YYYY) GENDER CITIZENSHIP LIFETIME PREMIUM LIFETIME AMOUNT VALIDITY
MEMBERSHIP AMOUNT VALIDITY MEMBERSHIP
MALE FEMALE
Archer Quiver BRONZE P10,000 LIFETIME
FIRST NAME NICK NAME MIDDLE / MAIDEN NAME LIFETIME P5,000 LIFETIME
Archer Quiver SILVER P20,000 LIFETIME
COMPANY POSITION
NON-LIFETIME
MEMBERSHIP AMOUNT VALIDITY CARD REPLACEMENT AMOUNT VALIDITY
PERSONAL EMAIL ADDRESS BUSINESS EMAIL ADDRESS
RENEWAL P2,000 2 YEARS REPLACEMENT P100
Carried over
from previous
is for lost or damaged card only.
card
You will be asked to submit a copy of an
LANDLINE (HOME) LANDLINE (WORK) MOBILE NO. NEW GRADUATES with P0.00 2 YEARS Affidavit of Loss.
BACHELOR’S DEGREE
2 years validity will start on the year of graduation
EDUCATION
LA SALLE SCHOOL DEGREE DEGREE CODE MONTH & YEAR YEARS PICK UP DELIVERY within the Philippines (P150) outside the Philippines (P250)
GRADUATED OF STAY
BACHELOR’S DEGREE DELIVERY ADDRESS same as in HOME ADDRESS
DLSU MA / MS / MBA / Law / PhD
2-Yr Certificate/Diploma Program
DLSU GRADE SCHOOL
INTEGRATED SCHOOL HIGH SCHOOL
(from 2013) SENIOR HIGH SCHOOL IN CASE OF EMERGENCY
NAME OF CONTACT
DLSU GRADE SCHOOL
(up to 1984)
RELATIONSHIP TO APPLICANT
DE LA SALLE COLLEGE
HIGH SCHOOL ADDRESS
(up to 1968)
Those who have enrolled, but not necessarily graduated, for at least 6 terms, can avail the DLSAA Card. CONTACT NO/S. EMAIL
Please indicate years of stay (e.g. 1973-1975). You will be asked to submit a copy of your TOR.
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College of BUSINESS College of LAW Yes, I want to receive the latest DLSAA updates by email, text message, or post.
GRADE & HIGH SCHOOL MANILA
College of COMPUTER STUDIES College of LIBERAL ARTS (GS up to ‘84; HS up to ’68)
College of EDUCATION College of SCIENCE DLSU INTEGRATED SCHOOL
2019OCT
College of ENGINEERING School of ECONOMICS (GS/HS/SHS from 2013 onwards)