Admission

CONFIDENTIALITY NOTICE

We value and protect your personal information in compliance with the Data Privacy Act of 2012 (RA 10173). The information you shared will be stored in a database accessible to UA only. These will be used to serve as a reference for your admission for entrance exam.

PERSONAL INFORMATION

First Name *

Last Name *

Middle Name

Name Extension0 / 5

Sex *MaleFemale

Date of Birth *

Email Address *The exam permit and result will be sent to this email address, so make sure it is active.

Contact no. *0 / 11

Present Address *Living in AntiqueLiving Outside Antique

Town *

Barangay *

Street/Purok

Street

Barangay/District

Town/City *

Province *

ZIP / Postal Code

SOCIO ECONOMIC INFORMATION

Are you a person with disability (PWD) ? *YesNo

Nature of Disability *

Please Specify *

What type of assitance do you need during the exam?

Are you a SOLO PARENT? *YesNo

Is your family a 4P's beneficiary? *YesNo

Is anyone in your immediate family a sugarcane worker (SACADA)? *YesNo

Is your family a member of INDIGENOUS PEOPLES GROUP (IP)? *YesNo

What type of Community? *

Please Specify *

Financial Support *Self SupportSupported by FamilySupported by Immediate FamilyWith Existing Scolarship

Nature of Job *

Name of funding agency *

FAMILY BACKGROUND

Father's Full Name *Format(First Name/ Middle Initial/ Last Name

Mother's Full Name *Format(First Name/ Middle Initial/ Last Name

Father's Occupation *

Mother's Occupation *

Are you the first child in your immediate family to be in college? *YesNo

Number of sibling in College/ Finished College *

EDUCATIONAL BACKGROUND

Last School Attended *Select others if school name is not listed

Others Specify *Name of School

Type of School *PublicPrivate

Section *

Year Graduated *0 / 9

Grade 12 Academic Distinction/Awards *With Highest HonorWith High HonorWith HonorNone

General Weighted Average *

Hobbies and Interest *

COLLEGE APPLICATION INFORMATION

Entry Classification *FreshmenTransfereeQuitterShifterFreshmen (New Student/ Incoming First Year) • Transferees (College Student applying for transfer to UA) • Quitter/Reternee (Former Student UA applying to enroll again) • Shifter (Change of Program)

Campus Intended to Study *Tibiao CampusHamtic CampusLibertad CampusCaluya Campus

Tibiao Campus Course Preferences

First Preference *

Second Preference *

Third Preference *

Hamtic Campus Course Preferences

First Preference *

Second Preference *

Third Preference *

Libertad Campus Course Preferences

First Preference *

Second Preference *

Caluya Campus Course Preferences

First Preference *

Second Preference *

Third Preference *

Residency and Connectivity

Type of Residency if Enrolled. *Living with ParentsBoarding HouseLiving with RelativesKasambahay

Type of ConnectivityType 1 - WITHOUT CONNECTIVITY (without android phone/IOS, no internet signal or WIFI)Type 2 - WITH LIMITED CONNECTIVITY (with internet ready devices but without steady internet signal or WIFI)Type 3 - WITH CONNECTIVITY (with internet ready devices and available and steady internet and WIFI)

Republic of the Philippines

University of Antique

Transforming Lives & Building Communities

Baccalaureate/College Application Form