CS-GO Form No. 1 (Rev.

10-09)
THE GRADUATE OFFICE
COLLEGE OF SCIENCE
UNIVERSITY OF THE PHILIPPINES
Diliman, 1101 Quezon City
Philippines
www.science.upd.edu.ph
APPLICATION FOR ADMISSION TO A GRADUATE PROGRAM
(Use additional sheets if necessary)
Instructions to Applicant:
1. Complete this form in duplicate. Type or print clearly.
2. Submit this form with the following to the above address:
a.) Formal letter of application addressed to the Dean,
College of Science, University of the Philippines,
Diliman, Quezon City (original and photocopy)

Attach 2 x 2
Photograph

b.) Pay cash at the U.P. Cashier or postal money order for P500 or
$25 bank draft (for foreign applicants) application fee, payable to
the University of the Philippines
c.) Official transcripts of undergraduate and graduate
records (four copies - 1 original copy and 3 photocopies)
d.) Certified copies of diplomas or certificates of graduation
(two copies each)
e.) Birth certificate from National Statistics Office (for Filipino Citizens)
(three copies - 1 original copy and 2 photocopies)
f.) Test of English as a Foreign Language (TOEFL) results or certification that the medium of instruction is English
for foreign applicants whose native language is not English. (three copies 1 original and 2 photocopies)
(see the list of passing scores)
Name: Ms/Mr. _____________________________________________________________________________________
(Last)
(First)
(Middle/Maiden)
Email Address : __________________________________________ Cell phone No. : ____________________________
Mailing Address: ____________________________________________________________________________________
________________________________________________________ Tel. No.: __________________________________
(State or Region)
(Country)
Permanent Address: _________________________________________________________________________________
________________________________________________________ Tel. No.: _________________________________
(State or Region)
(Country)
Age: _________________________ Sex: ________________________

Civil Status: _________________________

Date of Birth: ____________________________________ Place of Birth: ____________________________________

Month/Day/Year
Citizenship: ______________________________________ Nationality: _____________________________________
Graduate Degree Program Applied for:* _________________________________________________________________
Proposed Start of Graduate Study:
[ ] 1st Semester
[ ] 2nd Semester AY _____________________________
Source of Financial Support: __________________________________________________________________________
Are you applying under a special arrangement or scholarship program? (If yes, indicate
collaborating university or funding agency) _______________________________________________________________
*Please refer to the list of graduate degree programs offered by the College of Science

Have you applied to any other graduate program at any other time? (If YES, indicate
university, field of study, semester and year) _______________________________________________________
__________________________________________________________________________________________________
Academic Background (from secondary school to highest university education):

Name and Address of School

Inclusive Dates
(month & year)

Degree
Competed

Honors
Obtained

Academic Honors, Awards, Scholarships:

__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Membership in Learned Societies or Professional Organizations (indicates positions held, if any):
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________

Work Experience (list in chronological order)

Name and Address of Employer

Inclusive Dates
(month & year)

Position Held

Nature of Job

Scientific and technical papers published or presented in scientific meetings:

__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________

STATEMENT OF PURPOSE
Write a clear and concise essay of not more than 300 words on your purpose in applying to this graduate
program and your plans for graduate study, if admitted. Include your specific area/areas of interest, an assessment of
your academic, mental, and emotional preparedness for graduate study, and your future prospects.

REFERENCES
(Name at least two former professors or experts in your field whom you think are capable of objectively
evaluating your past performance and potential for success as a graduate student and professional in your chosen
field. Request these persons to complete the enclosed recommendation form, CS-GO Form No. 2(86), and to mail them
directly to the Graduate Office, College of Science, University of the Philippines, Diliman, Quezon City, 1101).

1)

Name: _____________________________________________________________________________________
Degree and Field of Specialization: ______________________________________________________________
Position: ___________________________________________________________________________________
Name and Address of Organization: _____________________________________________________________

(2) Name: _____________________________________________________________________________________

Degree and Field of Specialization: ______________________________________________________________
Position: ___________________________________________________________________________________
Name and Address of Organization: _____________________________________________________________

(3) Name: ______________________________________________________________________________________

Degree and Field of Specialization: _______________________________________________________________
Position: ___________________________________________________________________________________
Name and Address of Organization: ______________________________________________________________

I hereby affirm that all the above information is complete and accurate. I know that any false or misleading
information given by me can make me ineligible for submission or subject to dismissal. If admitted, I agree to abide
by the policies, rules, and regulation of the University of the Philippines.

_______________________
Date

_______________________________________
Signature of Applicant

_______________________________________
Printed Name