Form No UG-08 STATEMENT OF RESPONSIBILITIES In connection with the admission and enrollment of _, NAME OF THE STUDENT The person named below is the designated Parent/Guardian On Record at De La Salle University: De La Salle University – Science and Technology Complex LAST NAME FIRST NAME MIDDLE NAME Mailing Address: _ _ Relationship to Student: _ Telephone Number: _ Email Address: Mobile Number: As the Parent/Guardian, I understand and agree with the following: RESPONSIBILITIES The non-refundable fee of PhP5,000.00 will be credited to tuition and fees assessment upon enrollment for the term of the academic year and in case of withdrawal of confirmation, it will be charged against the administrative and processing costs (NOTE: Not applicable to students who defer enrollment); The Parent/Guardian On-Record must pay the tuition fee increase as decided by the DLSU-Multi Sectoral Committee, or the tuition fee increase mandated by the government, if any, for the duration of our child’s stay in the University; The Parent/Guardian On Record must abide by the rules and regulations governing our enrolment at De La Salle University, as specifically stated in the Student Handbook and/or other University circulars/memoranda; The Parent/Guardian On-Record must attend official activities of the DLSU PUSO (Parents of University Students Organization), the parent organization acting as liaison between DLSU parents and the rest of the school community; and The Parent/Guardian On-Record has equal access to the student’s official school records through the My.LaSalle Parent account CONDITIONS (For Parent/Guardian On-record) The Parent/Guardian On-Record shall be the addressee of all communications, if any, sent by De La Salle University Communications may be sent to any of the contact information provided herein, and that the same is active and valid until superseded through a written notification by the Parent/Guardian On-Record; The Parent/Guardian On-Record shall be the payee of all checks in connection with tuition refunds, if any; The student named above may act as Parent/Guardian On-Record when of legal age, subject to the procedures for changing Parent/Guardian On-Record; A change of the Parent/Guardian On-Record requires the authority of the undersigned and the current Parent/Guardian On Record through a notarized Affidavit of Change of Parent/Guardian On Record; The administrative costs in connection with a change of the Parent/Guardian On-Record may be assessed by De La Salle University; _ SIGNATURE OF PARENT/GUARDIAN OVER PRINTED NAME _ DATE SIGNATURE OF STUDENT OVER PRINTED NAME DATE **Note: This form must be accomplished in duplicate 2401 Taft Avenue, 1004 Manila, Philippines | Direct Line: (632) 523-4230 | Trunk Line: (632) 524-4611 loc 166 admissions@dlsu.edu.ph | www.dlsu.edu.ph/admissions