To make an appeal to UPOU, please do the following:

1. complete this form and upload a copy of your Letter of Regret received from the Office of Admissions; and
2. complete the Distance Education Readiness Module (DERM).

Instructions on how to complete the DERM are found at http://our.upou.edu.ph/details.php?id=101

The deadline for submission of appeals and completion of the DERM is 10 May 2019. Results of your appeal will be emailed to you on 15 May 2019.

Email address *
Last Name *
First Name *
Middle Name
Address 1 (street, subdivision, town) *
Address 2 (city, province, zip code) *
Intended Course in UPOU *
Upload Letter of Regret (max size: 10 MB) *
Contact/Mobile Number *
Consent and Assent
I hereby affirm that all information supplied herein is complete and accurate. I understand that withholding information or giving false information will make me ineligible for admission, or if admitted, subject to dismissal. If admitted, I agree to abide by the policies, rules and regulations of the UP Open University.

I have also read the University of the Philippines’ Privacy Notice for Students (https://www.upou.edu.ph/up-data-privacy-notice-for-students/).

I grant my consent to and recognize the authority of the University of the Philippines to process my personal and sensitive personal information, pursuant to the abovementioned Privacy Notice and applicable laws in connection with my application to shift/transfer/be admitted as a student of UP Open University.

Consent and Assent (Agree) *
Never submit passwords through Google Forms.
This form was created inside of University of the Philippines Open University. - Terms of Service