REPUBLIC OF THE PHILIPPINES Reference Number:
POLYTECHNIC UNIVERSITY OF THE
PHILIPPINES OFFICE OF THE
UNIVERSITY REGISTRAR ADMISSION
AND REGISTRATION SERVICES STA.
MESA, MANILA Selected NSTP:
SAR-FORM 1
WITH CONFIRMATION DOCUMENTS
Confirmation Slip (For a 4 or 5-year degree, or 3-year diploma program)
Attach recent
TheUniversity Admission Committee, 2 × 2" photo
here
I ,
(Name
am )
gra uated in
from
would like to confirm my interest to be admitted and enrolled this First Semester, Academic Year 2024-2025 in a program where I am
qualified based on the Specific College Criteria.
Respectfully yours,
Signature over Printed Name of Applicant Note: Read carefully the freshman admission and enrollment procedure.
This form contains personal-identifiable information that is subject
to Data Privacy Please keep this form protected and in a safe place
REPUBLIC OF THE PHILIPPINES Reference Number:
POLYTECHNIC UNIVERSITY OF THE
PHILIPPINES OFFICE OF THE
UNIVERSITY REGISTRAR ADMISSION
AND REGISTRATION SERVICES STA.
Selected NSTP:
MESA, MANILA
SAR-FORM 1
WITH CONFIRMATION DOCUMENTS
Confirmation Slip (For a 4 or 5-year degree, or 3-year diploma program)
Attach recent
TheUniversity Admission Committee, 2 × 2" photo
here
I ,
(Name
am )
gra uated in
from
would like to confirm my interest to be admitted and enrolled this First Semester, Academic Year 2024-2025 in a program where I am
qualified based on the Specific College Criteria.
Respectfully yours,
Signature over Printed Name of Applicant Note: Read carefully the freshman admission and enrollment procedure.
This form contains personal-identifiable information that is subject
to Data Privacy Please keep this form protected and in a safe place
ROUTE AND APPROVAL SLIP
ACADEMIC YEAR 2024-2025
Name of Applicant:
Reference Number: Date of Enrollment:
SHS
Track/Strand:
The application for admission and enrollment shall be processed and approved only upon compliance to the following requirements:
Step1: Submission of admission credentials at the Admission and Registration Services Section
Processed by: Remarks:
Grade 12 GWA:
SHS Strand: Non-SHS
Admission Status:
PUPCET Qualifier PUPLHS/SHS Indigenous People
Academic Scholar Athlete SK Chair
Artist Journalist Child of Solo Parent
ALS First Generation Student
Signature Date PWD, please specify:
Step 2: College Interview and Tagging of Program (This shall be filled-out by the interviewer only if the
applicant is qualified)
Interviewed by:
Program: _ Section:
Signature Date
Step 3: Medical Examination
Submission of Chest X-ray with film and Health Remarks:
Information Form for Students. (Validity of the Chest X-
ray result should be not more than 6 months from the
scheduled enrollment)
Processed by:
Signature Date
Step 4: Printing of Registration Certificate
Issued by:
Signature Date
Step 5: Printing and Claiming of Identification Card
Issued by:
Signature Date
These documents contain personal-identifiable information that is subject to Data Privacy.
Please keep these documents protected and in a safe place.
PUP-HIFS-6-MEDS-020
Rev.2
March 22, 2022
Republic of the Philippines
POLYTECHNIC UNIVERSITY OF THE PHILIPPINES
Office of the Vice President for Administration
2x2 or passport
MEDICAL SERVICES DEPARTMENT size Current colored
ID photo
HEALTH INFORMATION FORM FOR STUDENTS
PART I. STUDENT INFORMATION
Name: PUP Student No.:
Home Address: School Year:
Age: Sex: Civil Status: Course / College:
Blood Type: Email Address:
Parent's Name / Guardian / Spouse:
Landline:
Cellphone:
PART II. MEDICAL HISTORY
1. Do you need medical attention or has known medical illness? ⬜ No ⬜ Yes
(Please check the following that apply and give more information as needed)
⬜ Asthma ⬜ Loss of Consciousness ⬜ Eye Disease/Defect ⬜ Accident Injuries
⬜ Diabetes ⬜ Heart Disease ⬜ Kidney Disease ⬜ Tuberculosis / Primary Complex
⬜ Convulsion/Epilepsy ⬜ Hyperventilation ⬜ Hemophilia
⬜ Migraine ⬜ High Blood Pressure
⬜ Others (Pls. Indicate):
2. Do you have disability? ⬜ No ⬜ Yes, What type of
disability?
3. Additional Information for Students and Medical Conditions:
As a Parent/Guardian, I would like to declare that my child had history of allergies to the following:
Food: No Known Allergies:
Medicines: ⬜ Aspirin ⬜ Ibuprofen ⬜ Amoxicillin
⬜ Mefenamic Acid ⬜ Penicillin ⬜ Others:
PART III. PERSONAL SOCIAL HISTORY
Cigarette Smoking: ⬜ Yes ⬜ No
Alcohol Drinking: ⬜ Yes ⬜ No
I hereby certify that the medical health information given to PUP Medical Services are true, correct and fully disclosed to the best of my knowledge and all the
medical condition that may affect in the assessment for purpose of consultation/ issuance of medical clearance/ certificate as a student of PUP.
I also understand that the PUP MSD and the University will not be liable for any untoward incident that may arise due to any failure to disclose accurate
information or intentionally providing false and deceptive information.
In compliance with the Data Privacy Act of 2012 and its IRR, I voluntarily consent to the collection, processing, and storage of my personal and health
information for the purpose/s of health assessment/ treatment/ or research following research ethics guidelines for the improvement of healthcare services.
Signature of Parent/Guardian for students below Printed Name of the Student and Signature Date
18 years old
For PUP Physicians Only
Please Check
Medical Clearance: ⬜ Issued ⬜ Pending, Reason:
Date Physician’s Name and Signature
NEW STUDENT ADMISSION AND ENROLLMENT PROCEDURE
ACADEMIC YEAR 2024-2025
Note: Read and understand this document carefully
1. Download and print the Admission Documents (SAR Form 1, Route and Approval Slip, Health
Information Form for Students, Certification/Undertaking Form 2, and this Document).
2. Submit the following entrance credentials/documents to the Admission and Registration Services Section.
2.1. For Graduates of Senior High School AY 2023-
2024
2.1.1. Original High School Card (F138/Grade 12 Card)
2.1.2. Original or certified true copy of Grade 10 and 11 card
For further inquiries, clarifications, or in
2.1.3. Original PSA Birth Certificate case of error, email
[email protected]
2.1.4. Certification of Good Moral Character issued by with Message Subject: First Year
Principal or Guidance Counselor with school dry Enrollment Concern – Sta. Mesa
seal Manila
2.1.5. Duly signed Waiver/Certification/Undertaking
(Waiver is attached in this Confirmation Slip)
2.1.6. Chest X-ray result (Validity of the Chest X-ray result should be not more than 6
months from the scheduled enrollment)
2.1.7. Duly accomplished Health Information Form for Students
2.1.8. Two (2) pcs 2x2 inches colored picture with white background and student's name on the photo
2.1.9. One (1) pc. long brown envelope
2.1.10. For person with disability: PWD ID or PWD certification issued by the local government unit
2.2. For Previous Senior High School Graduates/High School Graduates of Past School Year/s
In addition to the above admission requirements:
2.2.1. Certification from the respective senior high school registrar with school dry seal and
noted by the Principal that no copy of F137A has been sent to other college or
university
2.2.2. Notarized certification by the SHS Principal of non-enrollment for high school/senior
high school graduates that they have not enrolled in any technical/diploma/degree
program immediately after graduation
2.2.3. Notarized Waiver that if there is concealment of previous enrollment, PUP enrollment
becomes null and void
2.3. For Graduates of Alternative Learning System
2.3.1. Certificate of Completion
2.3.2. Certificate of Rating
2.3.3. Verified/Certified True Copy of National List of Passers which shows the name of the student
2.3.4. Certificate of Good Moral Character issued by the school last attended
2.3.5. Original PSA Birth Certificate
2.3.6. Two (2) pcs of 2x2 inches colored picture with white background and with the student’s
name on the photo
2.3.7. One (1) pc. long brown envelope
2.3.8. For person with disability: PWD ID or PWD certification issued by the local government unit
3. Proceed to college/department for interview and enrollment/tagging of program.
4. Proceed to the Medical Services Department for submission of Chest X-ray and Health Information Form for
Students
5. Proceed to the Admission and Registration Services Section for printing of Registration Card.
6. Issuance of Identification Card.
WELCOME TO THE
PUP COMMUNITY
Your admission to the University is valid and official if you have
complied with all the admission requirements duly
acknowledged by the Admission and Registration Services
Section.
The first day of classes is on September 9, 2024.
No student will be allowed to attend
classes without the Registration
Certificate.
Now that you are officially enrolled,
access your PUP Student
Information System (PUPSIS)
account for the following:
Verification and updating of personal
data. For discrepancy found in your
A student's guide on how to use the name, gender, and date of birth,
PUPSIS: download from PUP Website the
Request for Correction of Name
and/or Date of Birth form and
proceed to the Office of the
University Registrar
Possible announcement/ advisory
Enrollment data and schedule
Registration Certificate
Health Declaration Form (if required)
and other downloadable forms
Scholastic Record
PUP Guidelines on Scholastic
Qualification for Free Education
ver. 2021 (Form 2)
CERTIFICATION/UNDERTAKING
I, , of legal age, Filipino, with residence
and postal address at , hereby certify THAT:
1. I am an enrollee of Polytechnic University of the Philippines
(PUP), (Please check one): ▢ Sta. Mesa, Manila
▢ Campus:
(State the Campus)
2. In compliance with the documentary requirements of the aforementioned University, among others, I am
submitting/undertake to submit the following documents on the date of enrollment:
a. Original Senior High School Card (F138 / Grade 12 card)
b. Original or certified true copy of grade 10 & 11 high school card.
c. Original PSA Birth Certificate.
d. Certificate of Good Moral issued by the SHS Principal/or Guidance Counselor with school dry seal.
e. Chest X-ray result (Validity of the Chest X-ray result should be not more than 6 months from the
scheduled enrollment)
f. Duly accomplished Health Information Form for Students
g. Duly signed Certification Under Oath, Form 2
h. Two (2) pcs. 2 in. x 2 in. colored picture with white background with nametag.
i. One (1) pc. long brown envelope.
j. For differently abled students / PWD and member of the indigenous people: ID or Certification issued
by the local government unit.
For Senior High School Graduates/High School Graduates of Past School Year/s
In addition to the above admission requirements:
k. Certification from senior high school registrar with school dry seal and noted by the Principal that no
copy of F137A has been sent to other college or university.
l. Notarized certification of non-enrollment by the SHS Principal of non-enrollment for high
school/senior high school graduates that they have not enrolled in any technical/diploma/degree
program immediately after graduation.
m. Notarized Waiver that if there is concealment of previous enrollment, PUP enrollment becomes null
and void.
For Graduates of Alternative Learning System
a. Certificate of Completion
b. Certificate of Rating
c. Verified/Certified True Copy of National List of Passers which shows the name of the applicant
d. Certificate of Good Moral Character issued by the school last attended
e. Original PSA Birth Certificate
f. Two (2) pcs of 2x2 inches colored picture with white background and with nametag.
g. One (1) pc. long brown envelope
3. I undertake to submit SF10 / Form 137-A with remarks “Copy for Polytechnic University of the Philippines”
before the start of the Second Semester of Academic Year 2024-2025. I understand that non-submission of
the said document will be a ground for non-enrollment in the succeeding semester;
4. I vouch the authenticity and genuineness of the documents I submitted/will submit to PUP;
5. I undertake and assume full and complete responsibility for all the consequences which may arise in case
any of the documents I submitted is found to have been falsified or fabricated;
6. I VOUCH THAT I HAVE NOT ENROLLED IN ANY HIGHER EDUCATION INSTITUTION INCLUDING ANY
BRANCH OR CAMPUS OF PUP OTHERWISE MY ENROLLMENT WILL BE CANCELLED.
7. I understand that my admission is merely provisional and that the University reserves its right to deny my
application for enrollment or revoke my enrollment should the information I declared or documents
submitted have been found to be deceitful, fabricated and falsified without prejudice to filing a criminal case
against me; and
8. I am executing this Undertaking in order for the University to proceed with my enrollment.
Signature above Printed Name of Enrollee
ATTESTED by: Date: ____________________________
_______________________________________________________________
Signature above Printed Name of Parent/Guardian
PUP Academic Program Admission Criteria
(Scan the QR code or click the link below)
https://bit.ly/PUPCET2024-Admission-Criteria
