Online Registration Form
Welcome to the UPHSD Online Registration Form!

In view of the current COVID-19 Community Quarantine, you may register here to reserve a slot.

You will receive a confirmation message for your registration. Please note that this form is only the first step in the reservation process. Additional requirements shall be completed for us to proceed.

Kindly accomplish the online application form below:
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TYPE OF APPLICANT *
STUDENT'S LAST NAME *
FIRST NAME *
MIDDLE NAME *
GRADE LEVEL BEING APPLIED FOR *
MOBILE NETWORK *
MOBILE NUMBER *
LANDLINE NUMBER
EMAIL ADDRESS
GENDER *
DATE OF BIRTH *
MM
/
DD
/
YYYY
ADDRESS *
CITY / PROVINCE *
CURRENT SCHOOL *
TYPE OF SCHOOL *
SCHOOL ADDRESS *
CITY *
FATHER'S NAME *
MOBILE NETWORK *
MOBILE NUMBER *
OCCUPATION *
JOB CLASSIFICATION *
MOTHER'S NAME *
MOBILE NETWORK *
MOBILE NUMBER *
OCCUPATION *
JOB CLASSIFICATION *
Approximately total combined monthly income of Parents or Guardian *
LEARNER REFERENCE NUMBER
OTHER SCHOOL APPLIED IN
1st Choice *
2nd Choice *
3rd Choice *
ARE YOU AN ALUMNI OF UPHSD? If yes, please indicate the campus location and year graduated *
CAMPUS LOCATION
YEAR GRADUATED
DECLARATION COMPLIANT TO THE DATA PRIVACY ACT
I hereby authorize the University of Perpetual Help to collect, process, and use the information for legitimate purposes, including but not limited to answering inquiries, and allow authorized personnel to process the information, store, save, secure, and protect database, and destroy the same in accordance with the laws, rules and regulation. *
Required
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