INTERNATIONAL CLUB OF THE UNIVERSITY OF THE PHILIPPINES

Room 210, Vinzons Hall

University of the Philippines Diliman, Quezon City, 1101

Legal Name:
Last Name Given Name Middle Name

Nickname:

Present Address:
Zip Code: Telephone Number:
Permanent Address:
Zip Code: Telephone Number:
Cell phone Number: Email Address:
Birth Date: Age: Place of Birth:
Native Country: Citizenship: Religion:
Sex: Male Female Civil Status: Single Married


Fathers Name: Living: Deceased:
Native Country: Citizenship: Occupation:
Mothers Name: Living: Deceased:
Native Country: Citizenship: Occupation:
Guardians Name: Relation:


Student Number: Academic Year: Semester:
College: Degree/Major: Year:

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PERSONAL INFORMATION
FAMILY INFORMATION
ACADEMIC INFORMATION

CLASS SCHEDULE
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Hobbies and Interests:

Languages Spoken:

Year and Semester of Application: Batch Name:
Number of Semesters Active:
Positions Held in ICUP:
Previous Committees You Belonged to:
In a few words, evaluate ICUPs performance last academic year:

New Suggestions/Activities:
Other Organizations You Belong To:

I hereby pledge to fulfill my duties and responsibilities as member of the International Club of the
University of the Philippines, respect and obey its duly elected officers, and defend and uphold the
ideals and spirit of the club as embodied in its constitution.

Signature Date


ADDITIONAL INFORMATION
MEMBERSHIP PLEDGE