Current University/College/School: ________________________________________

has earned college credit from

has not earned any college credit

NOTE: ORIGINAL AND PHOTOCOPY OF DOCUMENTS MUST BE PRESENTED UPON APPLICATION.

TALENT DETERMINATION TEST (TDT)

APPLICATION FORM

Instructions:

1. Please type entries or write legibly 2. Proper noun should be written in full and not in abbreviated form 3. Please mark [x] boxes properly

At least, 80% AVE in the third grading period, ________% 3 pcs. 2” x 2 “colored ID pictures

Copy of K-12 Report Card or Certified True Copy of Grades

Certification as a candidate for K-12 graduation in the current SY

NAME ___________________________________________________________________________ Last First Middle/Maiden

ADDRESS ___________________________________________________________________________

IF ACCEPTED, WHERE DO YOU PLAN TO LIVE? _____________________________________________

BIRTHDAY ______/_______/___________ BIRTHPLACE ________________________

SEX MALE FEMALE

CIVIL STATUS SINGLE WIDOWER MARRIED SEPARATED

CITIZENSHIP _______________________ RELIGION __________________________

MOBILE PHONE NUMBER _______________________________________

EMAIL ADDRESS _______________________________________________

DO YOU HAVE A DISABILITY? YES NO

IF YES, PLEASE SPECIFY AND ATTACH MEDICAL CLEARANCE: ________________

DO YOU HAVE MEDICAL CONDITION? YES NO

IF YES, PLEASE SPECIFY AND ATTACH MEDICAL CLEARANCE: ________________

ARE YOU A WORKING STUDENT? YES NO IF YES, WHAT WORK? ________________________

SCHEDULE _______________________________________ MONTHLY INCOME ₱_________________________

DO YOU HAVE ANY OTHER TALENTS? ____________________________________________________

DID YOU TAKE THE UPCAT? YES NO

IF SO, WHAT WERE YOUR CHOICES? 1ST

CHOICE: ____________________ 2ND

CHOICE: _______________________

OTHER SCHOOLS APPLIED ______________________ WHAT COURSES? _______________________

ARE YOU A MEMBER IN ANY ART GROUP/INSTITUTION? YES NO

IF YES, PLEASE SPECIFY ___________________________________

NAME OF FATHER _____________________________________ OCCUPATION ________________

NAME OF MOTHER ____________________________________ OCCUPATION ________________

MONTHLY FAMILY INCOME ₱ ____________________________ NO. OF SIBLINGS __________

SOURCE OF EDUCATION FUND

FAMILY INCOME SCHOLARSHIP _____________________________________

OTHERS _________________________________________________________________

DO YOU HAVE RELATIVES IN THE FIELD OF ART? YES NO

IF YES, PLEASE SPECIFY ___________________________________________

PERSONAL INFORMATION COURSE APPLYING FOR

Please attach recent

colored photo ID here

2“ x 2”

DEGREE APPLYING FOR

CONTROL NUMBER

This will serve as your TDT ID number

Certificate Program

Industrial Design

Painting

Sculpture

Visual Communication

TO BE ACCOMPLISHED BY THE FACULTY INTERVIEWER

Date of Interview: _____/______

Interviewed by:

Name and Signature of Interviewer

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Use this space to explain your choice of major and use extra sheet if necessary. (Minimum 0f 200 words)

I, ______________________________________________________________, hereby certify that all information given

above are correct.

I also grant my consent to the UP System, especially the College of Fine Arts, to carry out its mandate under the 1987

Constitution, the UP Charter, and other laws that the CFA must necessarily process my sensitive personal information.

________________________________ _________________________________________________

Signature of Applicant Name and Signature of Parent/Guardian (if student is a minor)

UNIVERSITIES/SCHOOLS ATTENDED STARTING FROM HIGH SCHOOL DIPLOMA/TITLE/DEGREE YEAR OF GRADUATION

Page 2 of 2

NOTE: ORIGINAL AND PHOTOCOPY OF DOCUMENTS MUST BE PRESENTED UPON APPLICATION. Original copies will only

be used as reference while photocopies submitted will be the property of CFA and will not be returned.

ONLY APPLICATIONS WITH COMPLETE ATTACHMENTS WILL BE CONSIDERED AND PROCESSED.