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UP Industrial Engineering Students

Committee
Department of Industrial Engineering and Operations
Research
University of the Philippines – Diliman,
Quezon City, Philippines 1104
School Year 2010-
2011

Personal Information
Name (Last name, Given name, Middle name)

Nick name Student Number (0X-XXXXX) Birthdate (mm/dd/yyyy)

Present Address

Permanent Address

Landline number Cellphone number (09XX- E-mail Address


IE Department Events ChecklistXXX-XXXX)
Organization Affiliation Are you a member of IESC this
academic year?
O Yes O No
Credentials and Commitments

Time M T W Th F S
8:30-10 O O O O O O
10-11:30 O O O O O O
11:30-1 O O O O O O
1-2:30 O O O O O O
2:30-4 O O O O O O
IE Department Attended? Comments/Suggestions for Improvement
4-5:30 O O O O O O
Events
IE Awards
Why wouldNight
you like to O
beYes O this committee?
part of Indicate your free time for an interview
No
Department O Yes O
Seminar No
GOP O Yes O
No
STD O Yes O
No
Pre-junior Talk O Yes O
No
IE Days O Yes O
No

Note: You may write at the back side of this application form.

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