OFFICE OF ADMISSIONS, UNIVERSITY OF THE PHILIPPINES

Kalaw Corner Quirino Streets UP Diliman, Quezon City 1101 Philippines

Telefax: +632 927-4561 Telephone: +632 981-8500 loc. 3287/3828/3830/3831
E-mail: upcatapplications@up.edu.ph Website: https://upcat.up.edu.ph/

REQUEST TO REVISE UPCAT 2020 APPLICATION FORM

You can submit this form together with Forms 1 and 2, or submit separately. You can submit in
person, thru an authorized representative (must bring authorization letter and an ID), or by
courier service. (The request should be addressed to the Director of the UP Office of
Admissions, using the mailing address shown above)
Deadline for submission of the request is on August 30, 2019.

I would like to request the following change(s) in my UPCAT application Form 1:

(Only the following can be revised in your UPCAT application form)

CHOICE OF CAMPUS

1st Choice : UP DILIMAN

2nd Choice : UP LOS BAÑOS

INTENDED COURSE IN 1ST CHOICE CAMPUS (UP DILIMAN)

1st Choice : BS Business Administration [4040]

2nd Choice : BS Business Administration and Accountancy (4.5 yrs) [4043]
3rd Choice : NONE
4th Choice : NONE

INTENDED COURSE IN 2ND CHOICE CAMPUS (UP LOS BAÑOS)

1st Choice : BS Economics [6145]

2nd Choice : BS Agribusiness Management [6175]
3rd Choice : NONE
4th Choice : NONE

TEST CENTER

Dasmariñas City, CAVITE [0433]

Please specify reason for request in change of test center (if applicable):

Approval of request will depend on availability of test permits for the requested test center

JERIKAH LUNA SIBOMIT

Name and Signature of Applicant

Date of Request: Jul 18, 2019

Application No. 1204458399

120-445-8399 07/18/2019 10:42 AM

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