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Application for Student Assistant and Graduate Assistant (New Applicant)
Data Privacy Act (DPA) of 2012
The University of the Philippines Open University (UPOU) recognizes its responsibilities under the Implementing Rules and Regulations of Republic Act No. 10173, known as the “Data Privacy Act of 2012”, with respect to the data collected and recorded. I hereby authorize the UPOU Office of Student Affairs to collect, process, and use the data indicated herein for other academic purposes. I understand that my personal information is protected by RA 10173, Data Privacy Act of 2012.*

Yes

Personal Information
Full Name*

First NameMiddle NameLast Name
Student Number*
Email*
example@example.com
Gender*
Citizenship*
Date of Birth*

MonthDayYear
Date
Contact Number*

Area CodePhone Number
Permanent Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Is your Mailing Address same as your Permanent Address?

Yes, it is the same as my permanent address.No, I have a different mailing address.
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Are you a UPOU student?*

YesNo
UP Constituent University*
What course are you currently taking?*
UPOU Degree Program*
Student Classification*
Year Level*
Expected Year to Graduate*
Do you have existing work?*

YesNo
Are you currently employed as a Teaching Fellow/Teaching Assistant at UP or another university?*

YesNo
Preferred Office to submit your application*

Office of the University RegistrarUPOU IRECUPOU RPCOffice of Student AffairsOffice of Public AffairsOffice of Gender ConcernsOffice of Ugnayan ng PahinungodFaculty of Management and Development StudiesFaculty of Information and Communication Studies
Upload the Requirements: (Merge the documents in one file. PDF filetype only.)*

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Application for Student Assistant and Graduate Assistant (New Applicant)