|
Application Data: |
|
School Group * |
|
Classify applicant's chosen Campus. |
|
Campus Site: |
|
|
| Course/Program (Priority) : * |
|
|
Course/Program (Choice 2):
|
|
Course / Program of the applicant
|
|
Course/Program (Choice 3):
|
|
Course / Program of the applicant
|
|
Year Level: * |
|
Year level of the student. |
|
Entry Classification: * |
|
Mandatory field. Classify applicant as Freshmen, transferee, cross enrollee or returnee for Pre-school, Grades school, JHS, SHS and college, and New Student for post-graduates. |
|
LRN: |
|
Classify applicant's LRN. |
|
School Year: |
2023 |
|
|
Term: * |
3rd Trimester |
School term of enrollment. |
|
Application Date: |
2024-04-20
|
If date is other than today |
|
Please submit at least one of the documents. |
|
|
SHS Report Card (for freshmen) Max. of 5MB*: |
|
Report Card. Required for verification of identity and initial screening. |
|
Transcript of Records (For Transferee/Cross Enrollee/Masteral/Doctoral) Max. of 5MB*: |
|
Transcript of Records . Required for verification of identity and initial screening. |
|
Personal Data: |
|
Surname: * |
|
Mandatory field. |
|
First Name: * |
|
Mandatory field. |
|
Middle Name: * |
|
Mandatory field. |
|
Sex: * |
Male
Female |
Mandatory field. |
|
Nationality: * |
|
Classify applicant's Nationality from available list. |
|
Religion: |
|
Classify applicant's religion from available list. |
|
Date of Birth: * |
|
Indicate date of birth to display. Mandatory field. |
|
Place of Birth: * |
|
Indicate Place of Birth. |
|
Civil Status: * |
|
Classify applicant's civil status from available list. |
|
Monthly Family Income: * |
|
Indicate average/estimated monthly income of household members. |
|
Contact Information: |
|
What country are you currently residing in? * |
|
|
|
Home Address: * |
|
|
|
|
|
Number, Unit, Street Name, Building |
Barangay, Barrio, Village, Subdivision,
District |
Municipality, City |
Province, Region and ZIP/Postal Code |
|
|
Home Phone No.: * |
|
(Area Code) Phone No. |
|
Mobile Phone No.: * |
|
(Area Code) Mobile Phone No. |
|
Billing Address:
|
|
|
|
|
|
|
|
Billing Address Tel No.: * |
|
(Area Code) Phone No. of your Permanent/Billing Address |
|
E-mail address: * |
|
Personal e-mail address. |
|
|
|
|
|
E-mail verification code: * |
|
Once you entered your e-mail, click the Send Verification Code button. You'll receive a confirmation e-mail on your indox or spam folder. Copy and paste it on the place holder. You may resend another verification code after a minute. |
|
In case of emergency |
|
Guardian / Contact Person: * |
|
In case of emergency. Mandatory field. |
|
Relationship: |
|
Relationship with the contact person given. |
|
Guardian / Parent Occupation: * |
|
Occupation of Guardian/Parent. |
|
Contact No: * |
|
Home phone number of contact person. Mandatory field. |
|
|
|
|
|
|
|
|
Family Data |
|
|
|
Stat |
LAST NAME |
FIRST NAME |
MIDDLE NAME |
RELATIONSHIP |
OCCUPATION |
|
|
|
|
|
|
|
|
|
|
|
|
Educational Background* |
|
|
|
Stat |
FROM |
TO |
EDUCATION TYPE |
COURSE/PROGRAM/STRAND |
NAME OF SCHOOL |
|
|
|
|
|
|
|
|
Application Survey* |
|
|
|
ENTRANCE/APPLICANT | | | 1 | How did you know about PWU? | | Website | Newspaper/Radio/TV | | Career Fair/Talk | Twitter | | Facebook | Instagram | | Relatives | Friends | | Alumni |   | | Other reasons(s), please specify | | | | | 2 | Why do you want to study at PWU? | | Positive feedback/Review about PWU | Near the place where I live | | Accessibility | Affordable Fees | | Offers the course I want | Recommended by family/friends | | Other reasons(s), please specify | | | | | 3 | Internet Access available (at home) | | Prepaid Wi-Fi | Broadband (DSL or Cable) | | Fiber-Optic (High-speed broadband connection) | Cellular/Mobile Data | | Other: | | | | | 4 | Do you have limited amount of data allowed for your internet access? | | Yes, my broadband plan (either DSL, Cable, or Fiber) has a data cap. | Yes, since I use prepaid Wi-Fi. | | No, my plan allows unlimited access to the internet. |   | | | 5 | If you are using Prepaid Wifi or data, approximately how often do you load your data allocation? | | Daily | Weekly | | Every 3 days | Monthly | | Every 15 days |   | | Other: | | | | | 6 | Approximately how much in Pesos do you load every time you load your device? | | Php | | | 7 | How many people in your household are sharing the internet connection? | | 1 - 3 | 7 - 9 | | 10 or More | 4 - 6 | | | 8 | How would you rate your internet connectivity at home? | | Very poor | Poor | | Fair | Good | | Excellent |   | | | 9 | Electronic Device/s available (at home) | | Personal Computer (PC) | Laptop | | Cellular/Mobile Phone | Tablet Computer | | Other: | | | | | 10 | Do any of these devices have a web camera? (Having a external web camera (hardware) is also acceptable) | | Yes | No | | | 11 | Do you have a home printer or printer supplies? | | Yes | No | | | 12 | The University is currently looking at sourcing mobile Wifi and/or tablet computers for next school year. Would you be interested to avail of one? | | Yes | No | | | 13 | If you answered Yes to the previous question, what kind of device would you wish to avail of? | | Mobile or Home Wifi Device | Both Wifi. device and Tablet computer | | Tablet Computer | None of the above | | | 14 | How much would you be willing to pay for a tablet computer should the University be able to provide student financing packages? | | Php 5,000 - Php 6,999 | Php 7,000 - Php 8,999 | | Php 9,000 - Php 10,999 | I'd be willing to pay Php 11,000 and above for a Tablet computer | | Thanks, but I'm happy with the device I'm currently using |   | | | 15 | Do you have any of the health/medical conditions below? Please check all that apply | | Asthma | Diabetes | | Serious heart conditions | Chronic kidney disease being treated with dialysis | | Chronic lung disease | Liver disease | | Severe obesity | None | | Other: | | | | | 16 | Are you living with a person with serious health/medical conditions? Yes or No, if yes please specify your relationship and the medical condition. | | | | | 17 | Are you living with a person who is aged 60 years and older? | | Yes | No | | | 18 | Are you living with child/children? | | Yes | No | | | 19 | How many child/children are you living with? | | 1 - 2 | 3 - 4 | | 5 and up |   | | | 20 | Age of the child/children. If more than 1 child, please list all ages of the children, | | Age | |
|
|
|
Application Disclosure Form* |
|
|
|
|
|
|
|
|
|
Determine what action to take for this application. |
|
|
|
|
* All indicated with (*) are mandatory or required fields. |
|