(As stated in Birth Certificate. Please PRINT or TYPE.

)
STUDENT APPLICANT Surname

First Name

ADMISSIONS CENTER Middle Name

2544 Taft Ave., Manila, Philippines 1004 Nickname

Tel Nos.: 526-7441 to 47 loc. 126, 220 & 221
Telefax: 524-8233
Email: admissions@dls-csb.edu.ph
Website: www.dls-csb.edu.ph/admissions Gender Male Female
Office Hours: Mon.-Fri. 8:00am-12:00nn &
1:30pm-5:00pm /Sat. 8:00am-12:00nn

Transferee Pre-Application Questionnaire

Check for the term-specific submission deadlines from the DLS-CSB Admissions Center. The DLS-CSB
Admissions Center shall not be responsible for missed deadlines.
1. PRINT or TYPE IN all necessary information required in this questionnaire. 2X2
2. After completion, submit this form and an updated Certified True Copy of Transcript Colored Picture
of Records with School’s Grading System as instructed below.
• For Day Program applicants from a non-La Salle school, submit your documents through the Admissions Drop
Box and return after 2 working days to inquire about the status of your pre-application.
• For Day Program applicants from a La Salle school, submit your documents directly to the Admissions Counter.
• For Career Development Program (Night Program) applicants, submit your documents to Admissions Counter.
You must also submit your Employment Certificate.
• For Second Degree applicants, submit your documents through the Admissions Drop Box and return after 2
working days to inquire of the status of your pre-application. You must also submit a letter stating the reason(s) for seeking a second degree.
• For former DLS-CSB students, submit your documents through the Admissions Counter and return after 3 working days to inquire of the status of your
pre-application. The approval of your return is subject to the re-admission policies of DLS-CSB.
Tel. No. __________________________________ Email Address ______________________________________________________
Cellphone No. _____________________________ High School/s Attended: ______________________________________________
Date of Birth ______________________________ Current College/University: ____________________________________________
Age ___________________________________ Current Year Level: ________________________________________________
List all Colleges/Universities Attended Prior to Last School Attended: __________________________________________________
1. Tick your present academic status
o Presently enrolled in college/university
o Ineligible for readmission
Reason(s) of ineligibility: __________________________________________________________________________________________________

o On official leave of absence (Submit certified true copy of approved Leave of Absence)
o Presently unenrolled but still eligible for readmission to current college/university
o None of the above
Status and reason for transfer: ___________________________________________________________________________________________

2. Is this your first time to apply at DLS-CSB? o Yes, proceed to Question #4 o No, proceed to Question #3

3. Explain your previous DLS-CSB application status by answering the following questions:
3.1 Date of previous DLS-CSB application: ________________________________________________________________________________________
3.2 Status of previous DLS-CSB application:
o I was accepted and confirmed but I withdrew my confirmation because: ____________________________________________________________
o I was accepted but I did not confirm.
o I was accepted and I enrolled but withdrew because: ___________________________________________________________________________
o I did not qualify during pre-application
o I was not accepted.
o Other reasons, please specify: ____________________________________________________________________________________________

4. Have you ever been charged with a major offense(s)/case(s) in any of the schools, including high school, you attended?
o Yes (Submit all documents pertinent to the offense/case)
o No

5. Have you ever been suspended, advised to transfer, or dismissed from any of the schools, including high school, you attended?
o Yes, please explain: _____________________________________________________________________________________________________
o No

6. Have you ever been a DLS-CSB student?

o No
o Yes, please answer the following questions:
DLS-CSB ID Number: ________________________ Last Term and School Year of Attendance: ____________________________________
Were you issued an honorable dismissal? No (Proceed to Question #7) Yes
Have you used your honorable dismissal? No Yes, indicate first school attended after DLS-CSB: ______________________________

7. What degree program are you seeking admission to at DLS-CSB? __________________________________________________________________

8. Are you a foreigner or immigrant?

o No
o Yes, please answer the following questions:
What is your status or type of visa?
o 9F Student Visa (Attach Photocopy) o Special Study Permit o 9A Tourist Visa o 9G Working Visa
o 9E Diplomat Dependent o SRRV o SIRV o 47(a)(2)
o Native Born o Sec. 13 o Others (Attach photocopy) _________________________________

Are you currently enrolled in a Philippine-based school? o No

o Yes, how many semesters did you study in your previous school? __________

Verification/Authorization
My parent/guardian and I have carefully read and noted the contents of this document. I hereby certify that the foregoing information (inclusive of
all attachments) is true and correct. I am fully accountable and responsible for any misrepresentation, fraud, deceit, concealment and other forms
of falsity in relation to the above disclosure. I understand that my admission to the College is subject to the final evaluation results based on my
compliance with the requirements, the entrance test, and other criteria considered by admission officials of the College. Therefore, I understand
that any criterion unsatisfactorily met may render me ineligible for admission despite compliance with the requirements. I understand that I will be
liable for expulsion in case of any misrepresentation employed by me or on my behalf during my stay in DLS-CSB.

Printed Name & Signature of Applicant Date Printed Name & Signature of Parent(s)/Guardian Date