Form No. UG-15
DECLARATION AS A TRANSFER STUDENT
In connection with my application at De La Salle University, I declare the following:
1.
That prior to my application with De La Salle University, I enrolled at the following schools for the
tertiary/college level with the following details:
Name of School
Address of School
Academic Year/Term
No. of Units
Earned
2.
That I have submitted an authentic and latest available copy of my Transcript of Records from my
last school attended;
3.
That I have not incurred a failing/incomplete (or its equivalent) grade nor have unofficially
dropped in any course/subject from my previous schools;
4.
That the details provided in this Declaration Form as a Transfer Student are true and correct;
5.
That I am authorizing De La Salle University to conduct a verification procedure to confirm the
details contained in this Declaration Form as a Transfer Student; and
6.
That I understand and agree that any misrepresentation or inaccuracy contained in this
Declaration as a Transfer Student Form may be ground for my dismissal from De La Salle
University and/or legal action against me, at any point during or after my stay at De La Salle
University.
Student
Parent On-Record
Signature over Printed Name
Signature over Printed Name
Date
Date
**Note: This form must be accomplished in duplicate.