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                                                              OFFICE FOR ADMISSIONS
                     COLLEGE                      AND           LEAPMED                            APPLICATION                             AND              CONFORME
Reference Number:                                                                                                    Application via:
2022503678                                                                                                            USTAR
 Legal Name (Name in Birth Certificate)
  REYES                                                                                                                                                                                      F
 Last Name                                                                                                                               Auxiliary Name (e.g. Jr., II, etc.)                Sex
  NICKIE ANGELYN
 Given Name                                                                                                                              Landline Number
  BELBAR                                                                                                                                  09657744684
 Middle Name                                                                                                                             Mobile Number
  02 / 05 / 2004                    FILIPINO                                            CHRISTIAN (CATHOLIC)                              nickieangelynreyes05@gmail.com
 Date of Birth (MM/DD/YYYY)        Citizenship                                          Religion                                         E-mail Address
  BLOCK 4 LOT 12 KALAYAAN C EXTENSION BATASAN HILLS QUEZON CITY                                                                                                                             1126
 Permanent Mailing Address                                                                                                                                                                 Zip Code
 Name of present Senior High School                                                                       Track/Strand
  COMMONWEALTH HIGH SCHOOL                                                                                ACADEMIC TRACK - SCIENCE, TECHNOLOGY, ENGINEERING &
 Address of Senior High School                                                                                                                                                 Grade 12 Completion Year
  ECOLS ST., COMMONWEALTH                                                                                                                                                      2022
 LEAPMed Applicant                                                  PRIORITY PROGRAM (College / Faculty / Institute and Program)        ALTERNATIVE PROGRAM (College / Faculty / Institute and Program)
  BACHELOR OF SCIENCE IN BASIC HUMAN                                CHEMISTRY - COLLEGE OF SCIENCE                                      BIOLOGY MAJOR IN MEDICAL BIOLOGY - COLLEGE
  STUDIES - FACULTY OF MEDICINE AND SURGERY                                                                                             OF SCIENCE
                     GENERAL GUIDELINES                                                                                APPLICATION PROCEDURE
   1.    Application to the University of Santo Tomas is done online.                                You are done with the pre-registration. Follow the steps below to complete your
   2. Only College applicants who are currently enrolled in Grade 12 may apply.                      application.
   3. The following may apply provided they first secure a clearance from the UST                    1. Log back in to your application portal.
      Office of the Registrar before paying the application fee:                                     2. Encode your application data:
         3.1 Passers of the Philippine Educational Placement Test and Alternative                       2.1 Complete the Grades Tab
             Learning System Accreditation and Equivalency (PEPT/ALS A&E certificate
             is required)
                                                                                                        2.2 Complete the Co-curricular and Extracurricular Tab
                                                                                                        2.3 Complete the Information Survey Tab
         3.2 Graduates/Completers of previous school years
             (original Form 138 - Report Card required)                                              3. Prepare the needed documents for uploading:
         3.3 Applicants from foreign schools                                                                 Signed Application and Conforme Form          Student Ranking Certification
             (original Form 137 - Transcript of Records required)                                            PSA/ NS0 Birth Certificate or Passport        Proof of Payment
         3.4 Foreigners graduating from local schools                                                        Certified True Copy of Form 137 or Form 138
             (passport and ACR I-CARD required)
                                                                                                             If applicable:
         3.5 Open this Google Form link to request:
                                                                                                             Honors Class Certification/s        Awards Certification/s
             https://forms.gle/eZSXsAo2EyiUA7496
                                                                                                             Leadership Certification/s          International Credential Certification
                                                                                                     4. Pay the application fee.
                        APPLICATION FEES
                                                                                                     5. Upload your application documents and click the “Submit” button in the
         Php            500.00 - Filipinos studying in the Philippines                                  Documents Uploading Tab.
         Php            500.00 - Filipinos studying abroad                                           6. Your documents will be reviewed upon submission of your application.
         Php          1,000.00 - Foreigners studying in the Philippines                              7. Your Application Receipt shall be released if your documents and information
         Php         3,000.00 - LEAPMED Applicants                                                      are complete and true.
         USD 30.00 or Php 1, 650.00 - Foreigners studying abroad                                     8. Visit the Activity Log in your USTAR application portal for updates, after
                                                                                                        submitting your application.
         USD 50.00 or Php 2, 750.00 - Through International Credentials
                                                                                                     9. Download your Application Receipt.
   I certify and fully understand that:
        1. All information in this form is complete and correct to the best of my                          9. I authorize the Office for Admissions of the University of Santo Tomas to
           knowledge and belief.                                                                              verify all data that I have provided.
        2. I have not withheld any information that might affect my admission.                           10. The following are grounds for disqualification, forfeiture of slot, and/or
                                                                                                             debarment in the succeeding term if discovered in the current term:
        3. The priority and alternative programs stated herein can no longer be
           changed nor altered.                                                                               10.1 Misrepresentation of information entered in the application portal
        4. Passing the USTAR is not the sole basis for admission to some Colleges.                            10.2 Violation of the application instructions
           Some Colleges may require additional entry assessment in the form of
                                                                                                              10.3 Non-submission of documents on time to confirm one’s enrollment, if
           an interview, talent test, and other similar activities.
                                                                                                                   qualified
        5. My final admission will also depend on the submission of my official
                                                                                                              10.4 Submission of missing, incomplete, or false documents
           documents and grades.
                                                                                                              10.5 Other acts not in conformity with the University’s policies.
        6. I have not been admitted to and/or debarred from any other tertiary
           school.
        7. All submitted documents will become properties of the UST Office for
           Admissions and can no longer be retrieved by me or my representative.
        8. I authorize that the results and other data herein contained may be used
           for research purposes.                                                                                      Signature of Applicant                                   Date Signed
                                                                                                                                                                               UST:S024-00-FO42