Don Mariano Marcos Memorial State University

OPEN UNIVERSITY SYSTEM

San Fernando City, La Union
www.dmmmsu.edu.ph
(072) 242-3608
ous@dmmmsu.edu.ph
https://www.facebook.com/DMMMSUOpenUniversity

Application Date: _________________________

Latest
2” x 2”
ID picture
with name tag in white
COLLEGE ADMISSION APPLICATION FORM
background

Name (Pls. Print): _________________________________________________________________________________

Last Name First Name Middle Name

LRN: _________________________________________ Birthdate: _________________________________________

HomeAddress: ___________________________________________________________________________________
(Barangay) (Municipality/City) (Province) (Zipcode)

E-mail Address: ___________________________________ CP No. _______________________ Sex: ____________

Please Check:
Incoming Freshman
School where graduated: _______________________________________________________________
Address: ____________________________________________________________________________
Track: _________________________________ Strand: ______________________________________
School Year Graduated: ________________________________________________________________
Transferee
School last attended___________________________________________________________________
Address:______________________________________ Sem/SY _______________________________

Course Preference: First Priority:_________________ Second Priority: _______________________________

Admission Requirements:
1. Two (2) pieces 2”x2” identical latest I.D. picture with name tag in white background
2. Authenticated Photocopy of Form 138/ Report Card (Senior High Graduates)
3. Authenticated Photocopy of grades/ Transcript of Records (for transferees) I hereby declare that all information in this
4. NAT Result (if available, for Senior High Graduates) application is true and correct. I understand that any
5. NCAE Result (if available, for Senior High Graduates) false information may be a ground for disqualification
for Admission in the University.
Please prepare the following for Enrollment:
1. Two (2) pieces 2”x2” latest I.D. picture with name tag in white background
2. Original copy of Form 138/ Report Card (Senor High Graduates) _________________________
3. Original copy of grades/ Transcript of Records (for Transferees) Signature of Applicant
4. Photocopy of PSA Birth Certificate
5. Authenticated Photocopy of Certificate of Good Moral Character
6. Photocopy of Chest X-ray result
7. Photocopy of Medical Certificate

Processed by: _____________________________________

Guidance Counselor/Date

For further inquiries, please contact:

MS. CLAUDIA DENISE BARBADILLO

Guidance Counselor, OUS
(+63) 915-772-9579
admission.ous@dmmmsu.edu.ph

providing more opportunities …