OFFICE OF THE RECRUITMENT AND ADMISSIONS

NEW STUDENT DECLARATION FORM

As part of my requirements for my admission and enrollment at the University of San Carlos, I declare
the following:

1) That I graduated from Senior High School with the following details:

Name of School :
Address of School :
Month/Year
:
Graduated

2) That I have not registered, enrolled or been admitted at the tertiary level in any school in the
Philippines or overseas;

3) That I have not used or surrendered my Senior High School Report Card, whether original or
duplicate, to another school for purposes of seeking admission at the tertiary level;

4) That the period between my graduation from High School and my admission to University of
San Carlos may be accounted for by the following activities:

Month/Year Activity

5) That the information provided in this declaration form as a New Student are true and correct;

6) That I am authorizing University of San Carlos to conduct verification check to confirm the
details contained in this New Student Declaration Form; and

7) That I understand and agree that any material misrepresentation or inaccuracy contained in this
Declaration Form as a New Student may be grounds for my dismissal from the University of San
Carlos and/or legal action against me, at any point during or after my stay at the University of
San Carlos.

Student Parent On-Record

Signature over Printed Name Signature over Printed Name

USC - Downtown Campus

P. d e l Ro s a r i o S t . C e b u C i t y, P h i l i p p i n e s 6 0 0 0
Email: admin@usc.edu.ph
w w w. u s c . e d u . p h