Alumni Id

In: Other Topics

Submitted By econoid
Words 407
Pages 2
University of the Philippines Los Baños
Alumni Association, Inc.
UPLB Alumni Center, Narra Rd., UPLB, College, Laguna
Tel. (049) 536-4649; Telefax: (049) 536-5536
Email. uplbaa@uplb.edu.ph; uplbaa@rocketmail.com

UPLB ALUMNI INFORMATION SHEET
Please print or type all answers.

PERSONAL
Mr./Mrs./Miss ___________________________________________________
Family Name
First Name
Middle Name
NOTE: Use name registered with the University. If you are an alumna and you subsequently get married, please

Please attach your picture here (2x2)

indicate also your maiden name in parenthesis. e.g. (nee: Miss Cruz)

STUDENT I.D. NO. ___________________
Title Preferred:_________(e.g. Dr., Engr.,etc.) Sex:_______ Civil Status: _______ Citizenship:_________
Date of Birth: ____________ Place of Birth:________________ Religious Affiliation:________________
Permanent Address: _____________________________________________________________________
_______________________________Tel. no./ Mobile no._______________________________________
Business Address:_______________________________________________________________________
_______________________________Tel. no. / Mobile no. ______________________________________
Fax:_____________________________ E-mail:_______________________________________________

NOTE: Please check address where you prefer to be contacted by mail for correspondences.

EDUCATIONAL BACKGROUND
A. Obtained from U.P.
Degree/Diploma/Certificate/Title
College/Unit
Date of Graduation
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
B. Obtained from non-U.P. institutions
Degree/Diploma/Certificate/Title
College/Unit
Date of…...

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