OUR Form No.

3
Revised 28Jun2018
STUDENT DIRECTORY
PLEASE WRITE IN BLOCK LETTERS. Use an X mark in answering information preceded by a box
STUDENT NUMBER NAME (Last, Given, Middle, If a married woman encircle maiden name.) COLLEGE DEGREE MAJOR
PHOTO
2015-91234 NG, LOVE GENESIS, LINOY SCIENCE MASTER OF ARTS PHYSICS

SEX CIVIL STATUS COUNTRY OF CITIZENSHIP DATE OF BIRTH

Single Widowed X Philippines SEPTEMBER 19, 1987
X Male
Female X Married Divorced PLACE OF BIRTH
________________________ _____________________ MANILA, PHILIPPINES
F _
PRESENT ADDRESS
e 553 PAVIA STREET TONDO MANILA PERMANENT HOME ADDRESS 553 PAVIA STREET TONDO MANILA
m
CONTACT NO. CONTACT NO. 09162082940
09162082940
a
EMAIL ADDRESS lovegenesis.ng@deped.gov.ph PARENT’S EMAIL ADDRESS N/A
l
SCHOOLS
e ATTENDED STARTING FROM HIGH SCHOOL DIPLOMA/TITLE/DEGREE
p DATE OF GRADUATION HONORS RECEIVED
FLORENTINO TORRES HIGH SCHOOL
__________________________________________________ MARCH 2003
HIGH SCHOOL DIPLOMA
___________________________
___________________ N/A
__________________
PAMANTASAN NG LUNGSOD NG MAYNILA
__________________________________________________ MARCH 2007
BACHELOR OF SECONDARY EDUCATION MAJOR IN PHYSICS
___________________________
___________________ N/A
__________________
__________________________________________________ ___________________________
___________________ __________________
__________________________________________________ ___________________________
___________________ __________________
__________________________________________________
ENROLLMENT IN THE UNIVERSITY OF THE PHILIPPINES ___________________________
___________________ __________________
SCIENCE
First Enrollment: UP College/School of ____________________________________________ 2ND SEM A.Y. 2015-2016
_ Year _______________________
Semester & Academic
SCIENCE
Last enrollment: UP College/School of ____________________________________________ Semester & Academic Year _______________________
2ND SEM A.Y. 2016-2017
Degree Obtained, If any _______________________________________________________ Semester & Academic Year _______________________

FOR READMISSION STATUS

During the period of AWOL/LOA, have you been enrolled in other schools/universities? YES X NO

If YES, please specify name of schools/universities ________________________________________________________________________________

_________________________________________________________________________________________________________________________

Do you have a disability? YES X NO If YES, please specify.i.e.,physical, psycho-social, cognitive,etc..) _______________________________

_____________________________________________________________________________________( Pursuant to RA 7277 and RA 9442)

Would you wish to avail of possible services for students with disability offered by the university? YES X NO

(Note that if you answer YES, your name, college, contact number, email address and class schedule will be included in the database of UPD
students with disability, and will be supplied to office/s and college/s that will implement services.)

Please enter your PWD ID number __________________________________ or SWSN ID number*_________________________________________

*You may apply for SWSN ID from the University Health Service.
PARENTS/GUARDIAN/SPOUSE Living /Deceased ADDRESS CONTACT NO. OCCUPATION
1. Father’s Name ___________________________
FROILAN G. NG
____________________________________ X 553 PAVIA STREET TONDO MANILA
___________________________ 09676450820
_____________ ADMINISTRATIVE AIDE III
_____________________
2. Mother’s Name ___________________________
MYRA L. NG
____________________________________ X 553 PAVIA STREET TONDO MANILA
___________________________ 09359311740
_____________ N/A
____________________
3. Guardian’s/Spouse Name ___________________________
ANGELIQUE G. NG
_____________________________________ X 553 PAVIA STREET TONDO MANILA
___________________________ 09260792075
_____________ N/A
____________________

PERSON TO BE NOTIFIED IN CASE OF EMERGENCY ADDRESS CONTACT NO.

ANGELIQUE G. NG 553 PAVIA STREET TONDO MANILA 09260792075

STUDENT PLEDGE:
I hereby certify that all information given above is correct.
In consideration of my admission to the UNIVERSITY OF THE PHILIPPINES and of the privileges of a student in this institution, I hereby
promise and pledge to abide by and comply with all the rules and regulations laid down by competent authority in the University and in
the College or School in which I am enrolled.

DATE ____________________________________________ SIGNATURE OF STUDENT_______________________________________

PLEASE INFORM THE OFFICE OF THE DEAN AND THE OFFICE OF THE UNIVERSITY REGISTRAR ABOUT ANY CHANGE IN THE ABOVE DATA.