Free Essay

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 Graduation
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
CIVIL SERVICE ELIGIBILITY/BOARD/BAR
Name of Examination
Place of Examination
Date
Rating
_____________________________________________________________________________________
_____________________________________________________________________________________
EMPLOYMENT RECORD (start from most current)
Name of Employer
Position/ Designation
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________

FAMILY RECORD
Name
Degree
School Attended
Inclusive Dates
Home Address
Spouse: _________________________________________________________________________________________
Children: _______________________________________________________________________________________
________________________________________________________________________________________
Father: _________________________________________________________________________________________
Mother: _________________________________________________________________________________________
Brother (s)_______________________________________________________________________________________
________________________________________________________________________________________
Sister(s): ________________________________________________________________________________________
________________________________________________________________________________________

OTHER INFORMATION
Area(s) of specialization / Expertise / Industry
_ Agriculture, Fishery and Forestry
_ Banking and Finance
_ Business and Management
_Community, Social and Personal Services
_Construction
_Education
_Health
_Humanities and Arts
_Information and Technology
_Insurance
_Law
_Manufacturing

_ Media and Communication
_ Military
_ Mining and Quarrying
_ Politics and Government
_ Public Utilities (Electricity, Gas, Water)
_ Real Estate
_ Science and Technology
_ Telecommunication
_ Transportation, Freight and Mail Services
_ Wholesale and Retail
_ Others _____________________
(please specify)

Languages Spoken: _______________________________________________________________________________________
Training & other Qualifications: _____________________________________________________________________________
Researches / Papers Written: ________________________________________________________________________________
_______________________________________________________________________________________________________
Awards/ Honors Received: _________________________________________________________________________________
________________________________________________________________________________________________________
Membership / affiliation in Professional Organization(s) (Including Boards, Clubs, Fraternities, Sororities, etc.)
________________________________________________________________________________________________________
________________________________________________________________________________________________________

CHARACTER REFERENCES:
Name
Position
Addresses
Tel. No.
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
DATE ACCOMPLISHED__________________________________ SIGNATURE: ___________________________
Preferences: Preferred Mailing Address: ____Residence
Preferred E-mail Address: ____Residence

______Business
______Business

Name:

Signature: must be at the center

Student Number:
Course/ Class:
Address:

Name:

Signature: must be at the center

Student Number:
Course/ Class:
Address:

Name:

Signature: must be at the center

Student Number:
Course/ Class:
Address:

Name:

Signature: must be at the center

Student Number:
Course/ Class:
Address:

Name:
Student Number:
Course/ Class:
Address:

Signature: must be at the center

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