Republic of the Philippines
LEYTE NORMAL UNIVERSITY
DIRECTOR OF THE ADMISSIONS OFFICE
P. Paterno St., Tacloban City
-o0o-
APPLICATION FOR COLLEGE ADMISSION FORM
Instructions:
1. Read the guidelines before filling out the form.
2. Fill out the form carefully and completely. Passport Size ID
3. Only complete forms will be accepted. Picture
4. Submit all required documents by the deadline. White background
5. Incomplete applications won't be processed. name tag.
6. Submitted documents become the property of the University and won't be returned.
COLLEGE OF _____________________________________
Application Details:
Entry Status: Academic Year: ___1st Semester ___2nd Semester ___Summer, SY 20__ - 20__
Freshman
Transferee PROGRAM PREFERENCE
2nd Courser (See list of programs offered by the University.)
__________________________________________
Program Name
PERSONAL INFORMATION
Applicant’s Name as in Birth Certificate:
________________________________________________________________________________________
Family Name First Name Middle Name
Date of Birth: ______________________ Age: _______ Gender: ________ Status: ________________
(Month, Day, Year)
Place of Birth: _________________________________ Citizenship: _______________________________
(City / Town, Province)
Permanent Home Address: ______________________________________________________________
(House Number, Street, Barangay, Town/City, Province, Zip Code)
Mailing Address (If not the same as above):
________________________________________________________________________________________
(House Number, Street, Barangay, Town/City, Province, Zip Code)
Religion:__________________ Mobile Number: _______________ E-mail Address: ___________________
FAMILY BACKGROUND
FATHER MOTHER GUARDIAN
(If not living with parents)
Name
Citizenship
F-ADM-001 Rev. 1 (11-10-23)
Contact Numbers
E-mail Address
Occupation/Position
(If employed)
Employer’s Address
EDUCATIONAL BACKGROUND
Learner’s Reference Number (LRN) as reflected in your report card or Form 138: _____________________
Name of School Address Year Honors Received
Graduated
Kindergarten
Elementary
Junior High School
Senior High School
College transferees and second coursers,
please list down all universities/colleges
attended.
Other Pertinent Information
Do you have previous application at Leyte Normal University? ( ) Yes ( ) No.
If yes, kindly indicate the Academic Year: ________
What are your hobbies, talents and interests? __________________________________________
Are you a member of any club or organization? ( ) Yes ( ) No. If yes, kindly indicate the name of the organization
or club: ___________________________________________________________
Do you have any PHYSICAL DISABILITY and/or CONDITION that requires additional support, special attention or
that should be taken into consideration in planning your academic activities?
( ) No ( ) Yes (specify) ________________________________________________________
______________________________________________________________________
(If necessary, please attach medical certificate and/or psycho-educational assessment report.)
F-ADM-001 Rev. 1 (11-10-23)
CHARACTER REFERENCES: Write down at least two (2) names and addresses of persons as character references
(teachers/advisers, guidance counselors, barangay officials, pastors).
Name Address Contact Number
PERSONAL STATEMENT:
Explain your purpose in seeking admission to the University and the goals which you want to achieve.
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
__________________________________________________.
I understand that my application for admission is subject to approval of the Admissions Committee of the University.
By signing below, I certify that the information given is true and correct. Falsifying any of the information is sufficient ground
for any legal action and rejection relative to my application. In addition, I understand that LNU has no obligation to provi de
me with reasons in case this application will be denied.
I know that the information collected relates to my admission and will be handled, processed, protected, shared,
retained and used by the University for its Pursuit of legitimate purposes.
I AGREE that the data pertaining to screening will be treated for:
• verification of my identity and determination of my eligibility to enroll in LNU;
• collection and records keeping during my stay in the University;
• publication/posting of my name, if qualified;
And shall be:
• destroyed one (1) year after my graduation/transfer;
• used for reporting for and by the Admissions Director, Guidance and Testing Office, and the University;
and
• Used for creating programs and activities of the Admissions Office and the Guidance and Testing
Office.
I AGREE further that if qualified to be a student of Leyte Normal University, I shall abide by all the rules and
regulations of the University.
Admissions Office Remarks
_________________________________ _________________
Signature over Printed Name Date
F-ADM-001 Rev. 1 (11-10-23)
