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UPCAT Form 2 (Rev. 3-2013)

VALID ONLY FOR UPCAT 2014
TO BE FILLED OUT ONLY BY PERSONNEL AUTHORIZED TO RECEIVE AND/OR PROCESS APPLICATIONS. Document Inventory Number

UNIVERSITY OF THE PHILIPPINES

SECONDARY SCHOOL RECORD
Transferee (PC 69) PC codes

FOR THE PRINCIPAL: (This official document is to be accomplished by the Office of the Principal/School Head.)
1. Eligible to take the UPCAT are the following: 3. Be sure that all the grades (i.e., including failing marks) for the first, the second, a) Senior students (e.g., Fourth Year, Grade 12, Senior 6) of DepEd-accredited schools and the third years are indicated; that all entries are complete and specific or secondary schools abroad (expecting to graduate at the end of the school year); with the number of units of credit for each subject; and that the marking system b) Graduates of DepEd-accredited schools or secondary schools abroad; used (bottom of this page), an explanation of the school's marking system, the c) Those declared eligible for admission to college after taking the Philippine Educational signatory's name in print, designation and signature in blue ink at the bottom Placement Test (PEPT). of both pages are provided. NOTE: All applicants must have final grades for the First, Second and Third Years of 4. Countersign all erasures and corrections made. the 4-year secondary school curriculum in schools with DepEd-recognition/permit to operate said curriculum (or, Grades 9, 10 and 11 or, their equivalent for 5. If the applicant is a transferee or has taken some subjects from another school international or foreign schools); and must not have taken the UPCAT previously. (e.g. for summer courses), then a signed and certified legible photocopy of the Permanent Secondary School Records (F137) from the other school must be Anyone who has taken/is taking/will be taking any college subject/s prior to or for the attached to this form containing all the grades earned therein. Likewise, if the semester/academic year for which the UPCAT is to be taken is not eligible to take the applicant needed more than 4 years to finish high school, a signed and certified UPCAT and will not be admitted as an incoming freshman in UP. photocopy of the F137 must be submitted. 2. Please type or print legibly all information called for in this Form 2. Do not abbreviate. 6. Please attach a signed certified photocopy of the Certificate of Government Place X marks in appropriate boxes. Recognition or Government Permit of each private school attended. No results may be released pending submission of this Form 2. Credentials filed in support of the application become the property of the University of the Philippines and will not be returned to the applicant.

NAME OF STUDENT: Print full name of the student. Place one letter in each box and leave one box blank between names.
LAST

FIRST

MIDDLE

Signature of Examinee

HIGH SCHOOL (where the student completed/is completing secondary level education)

HIGH SCHOOL ID: Do not write in these boxes.

Name of High School (Do not abbreviate)

Former Name (if any)

High School Mailing Address (Number and Street, Subd/Village, Barangay, City/Town, Province)

Date Established

Telephone/Mobile Number

E-mail Address

Is the school an annex? 2 No 1 Yes (if yes, please indicate the name of the mother school)
______________________________________________________________

Approximate number of expected high school graduates: School Year 2014 2015 2016 2017

High School Type: 1 Public general 2 Public science 3 Public vocational 4 Public barrio/barangay 5 UP-administered 6 State university/college 7 Private 8 Others (Specify) __________________________________________ How many curricula are followed in your school? ____________________ Type/s of Curriculum: 1 General Secondary/New Secondary Education 2 Science-oriented 3 Vocational-Technical 4 ACE (Accelerated Christian Education) 5 Special Program for the Arts 6 Basic Education/Revised Basic Education 7 Others (Specify) __________________________________________ Does the Marking System apply to every school year indicated at the back? 1 Yes 2 No (if no, please attach an explanation of the Marking System/s used for the years not covered)

School's Marking System: (For letter grades, please attach a copy of the Grading Scale with the numeric equivalent of each grade in the scale.) Highest Possible Grade Passing Grade Lowest Possible Grade

On a 100-point exam, how many points would a student have to get in order to merit a passing mark? 50 55 60 65 70 75 Others, please specify ______________

Other than the PRINCIPAL/SCHOOL HEAD, the persons with specimen signatures below are the only official signatories authorized to sign the Student Secondary Record (UP Form 2) and the Permanent Secondary School Record (F137). Other signatory/ies:

I certify to the accuracy of the foregoing data/information.

Principal's Signature (in blue ink):

Sample signature

Sample signature

Name in print

Name in print

Principal's Name(in print):

(Please specify designation)

(Please specify designation)

THIS FORM IS FREE OF CHARGE AND MAY BE PHOTOCOPIED.

For the PRINCIPAL/SCHOOL HEAD
NAME OF STUDENT: Print full name of the student. Place one letter in each box and leave one box blank between names.
LAST FIRST MIDDLE Date of Birth Place of Birth For the Applicant: Staple here

Staple a recent 2"x2" photograph (taken within the last six months) in this box. Be sure to print your name at the back of the photo.

Date of Elementary Graduation (Month) Father's Name (Last, First, Middle) Mother's Maiden Name (Last, First, Middle) ATTENDANCE IN SECONDARY SCHOOL Grade/Year Level School Year

(Year) Staple here

The High School Principal should please sign at the bottom of the photograph.

* Type of Curriculum

Name of High School (Do not abbreviate)

Address of High School

* 1 - General Secondary/New Secondary Education 2 - Science-oriented 6 - Basic Education/Revised Basic Education 7 - Others (Specify) Expected Year of Graduation

3 - Vocational-Technical

4 - ACE (Accelerated Christian Education)

5 - Special Program for the Arts

Total No. of Expected Graduates

Rank in the Graduating Class

REMINDERS: 1. Please enter all grades for the first, second and third years in the appropriate columns below. 2. For transfer students, please attach a signed and certified legible photocopy of the applicant's Permanent Secondary School Record (F137) from the other school/s with the signature (in blue ink) of the official signatory accompanied by the school's Grading Scale and an explanation of the school's marking system (stating the Highest Possible Grade, the Passing Grade, and the Lowest Possible Grade) as well as a certified true copy of Government Recognition or Government Permit of each private school attended, both signed by the official signatory. A Certified True Copy of academic records from a foreign school (if applicable) must be attached to this form. 3. An applicant who needed more than 4 years to finish high school must submit a signed and certified legible photocopy of his/her Permanent Secondary School Record (F137). 4. TOP RANKING STUDENTS (For Philippine public high schools only): If the applicant is among the school's TOP TEN students, please attach an official list of the TOP TEN graduates/prospective graduates of your school (ranking based on the overall first to third year academic performance as of the end of School Year 2012-2013 of students across all curricular programs and/or campuses of the school, NOT per annex) signed by the official signatory. 5. Please attach copy/ies of the school's secondary curriculum/la with units and electives (if any) clearly indicated.
Card F137tag HSID PC Card F137tag HSID PC Card F137tag HSID PC

CARD COUNT
In case student came from a different high school, write the name and address of the high school in these spaces.

FIRST YEAR / GRADE 9 School Year -

SECOND YEAR / GRADE 10 School Year -

THIRD YEAR / GRADE 11 School Year -

For transferees, please attach a certified copy of the transcript of records (F137) and marking system from the other school

SUBJECTS I. II. Filipino English Speech Reading/Writing III. Mathematics Algebra/Statistics Geometry/Trigonometry IV. Science Earth/Environmental Science Biology/Zoology Chemistry/Physics V. Makabayan VI. Araling Panlipunan VII. Tech & Home Economics (THE) Practical Arts Computer Education VIII. Foreign Languages

1 2 2 2 3 3 3 4 4 4 4 5 6 7 7 7 8 7 7 7

* *

Mark 'E' if Elective Final Grades Units Action Taken

1 2 2 2 3 3 3 4 4 4 4 5 6 7 7 7 8 7 7 7

*

Final Grades

Units

Action Taken

1 2 2 2 3 3 3 4 4 4 4 5 6 7 7 7 8 7 7 7

*

Final Grades

Units

Action Taken

IX. Vocational/Technical Subjects

X.

Academic subjects not listed above. Exclude MAPEH, Values, Religion, Character, Homeroom, P.E. or CAT:

XI. Summer Grades (if any)

Please attach certified true copy of grades/F137 if subject was taken from another school.

Affixed here is the school dry seal. This school has no dry seal.

I certify to the completeness and correctness of the foregoing record.

(Affix school dry seal here.)
Date School Head's Signature over Printed Name Official Designation