OFFICE OF THE UNIVERSITY REGISTRAR

APPLICATION FOR STUDY PRIVILEGES

For Non-Earning Dependents of U.P. Personnel
School Year: 2019-2020 Semester/Summer: First Semester

NOTE: The deadline for submission is the day before the first day of regular registration for each semester or summer.
========================================================================================================
Student Name: Alicia Anne B. Lantican Student No. 2014-72630 College: CM_____________
Home Address: Pulog Street, Umali Subdivision Los Banos, Laguna
A. I hereby certify that the above-mentioned student is my son/daughter/spouse and present is not
(pls. encircle)
Employed or has no other means of income.

Nacita B. Lantican Assistant Professor 7

Printed Name of U.P. Personnel Designation

__________________________________________ _______________IBS, CAS, UPLB________

Signature Office and Unit
B. I. For Currently Employed Personnel (To be accomplished by HRDO)
This is to certify that _________________________________ is a ( ) regular fulltime faculty/non-teaching staff ( ) regular
part time faculty ( ) faculty/non-teaching staff with temporary appointment* (co-extensive with the semester or term for which the
privilege is applied for) with the following status:

[ ] non on leave [ ] on vacation leave without pay

[ ] on sick leave [ ] on secondment to another gov’t agency of
[ ] on vacation leave with pay outside the country on academic assignment

2. For U.P. Retirees and other Personnel

This is to certify that ____________________________________ was already separated from the service in the
University due to ( ) compulsory retirement ( ) optional retirement ( ) death ( )disability on __________________________
With an aggregate service in the University of not less than ten (10) years.

_________________________ ________________________________________________
Date Chief, Human Resource Development
Office
C. (To be filled up the student) d. (To be accomplished by the Registrar’s Office)
Grades obtained during the Last Enrollment
2nd Semester/Summer, 2018 - 2019 Recommending Approval:

SUBJECT GRADE UNIT [ ] 100% discount on tuition, miscellaneous and lab fees
[ ] 50% discount on tuition, miscellaneous and lab fees
HD 201 1.75 6.5 [ ] not entitled to any discount
HD 202 1.75 6.0
HS 201 1.50 2.0
IDC 211 1.75 1.50 ________________________ ______________
IDC 211.1 2.00 4.5 Administrative Officer V Date
IDC 202 P 3.0
OS 201 2.25 6.0 Approved:
OS 202 1.50 7.0
OS 203 2.50 5.0 JOCELYN DEL MUNDO
OS 204 2.50 3.5 University Registrar
OS 205 2.25 7.0
OS 206 2.25 7.0 E. Subjects to Enroll (to be accomplished by the student)
Total No. of Unit 59.0
SUBJECT UNIT SUBJECT UNIT
This is to certify that the above-mentioned student has not
exceeded the allowed maximum residence and the grades for all the 1. HS 202 5.5 THER 201 4.0
subjects enrolled in as of the last day of late registration for said 2. OS 213 11.0 OS 215 9.0
semester/summer are complete and accurate. 3. IDC 212 1.0 IDC 203 3.0
4. OS 216 3.5 OS 211 9.0
________________________ ______________ 5. OS 212 9.0 OS 214 9.0
College Secretary Date 6. BIOCHEM 210 & NEURO 220 9.0

*Approved during 12r6yh BOR meeting last July 31, 2009