Application Form: Bicol University College Entrance Test

Bicol University OFFICE OF ADMISSIONS Legazpi City

APPLICATION FORM BICOL UNIVERSITY COLLEGE ENTRANCE TEST
SY 20 To Students and Parents: THIS FORM IS ONLY FOR APPLICANTS WHO HAVE NOT ENROLLED IN ANY COURSE/ SUBJECT BEYOND HIGH SCHOOL. CAREFULLY READ THE GENERAL INFORMATION FOR BUCET applicants and the contents of this form before filling in the information asked. Only CORRECTLY and COMPLETELY FILLED OUT FORMS will be issued a TEST PERMIT. PRINT ALL ANSWERS.

(BUCET)
- 20

Staple/Paste 2 pcs. 1x1 photo (recent)

Application Form No.
Appl. & Testing Fee: P150.00 O.R./M.O. No. Date Paid: Recorded by: PERMIT No.

GPA MATH0

E+

1. Intended Course. Print the CODE number of your FIRST and SECOND Choice of Courses and indicate the campus on the spaces provided below. Please refer to the BUCET GENERAL INFORMATION Sheet for the Course Code, Course Title and Campus. Courses indicated in this form are final. Changing of course(s) is strictly not allowed.

COURSE CODE NUMBER 1st Choice 2nd Choice

First

PREFERRED CAMPUS

Second

2. In case you did not qualify in your course choices, where do you plan to pursue your studies? (Enumerate possible schools) 3. PRINT OR TYPE YOUR NAME IN THE FOLLOWING SEQUENCE: Last Name, First Name, Middle Name. Place one letter in each box.

Last Name First Name Middle Name 7. PERMANENT HOME ADDRESS
Number and Street Subd./Village, Brgy. City/Town & Province Postal/Zip Code Tel./Cell. Phone No. 8. High School graduated or graduating from: High School Address 9. Applicant’s Date of Birth:

4. SEX Male 5. CITIZENSHIP: 6. RELIGION:

Check one box only:

Filipino Non-Filipino

Female

Expected/date of graduation Month Date
10. Civil Status (Check one box only)

11. Applicant’s Place of Birth: 12. Who will spend for your college education? My Parents Others (specify) 14. Number of children in the family: 13. Occupation of Father/Guardian: Occupation of Mother/Guardian: 15. Do you have any PHYSICAL DISABILITY or CONDITION that requires special attention or would make it difficult for you to take a regular test? Please attached Certification of Disability and Contact to BU Admissions Office 16. Monthly Family Income: P 20,000.00 – P 25,000.00 less than P15,000.00 P 25,000.00 – P 30,000.00 P15,000.00 – P20,000.00

Year

Single

Married

Other (specify)

No

Yes

P 30,000.00 – P 35,000.00 P Exceeding P 50,000.00

APPLICANT’S CERTIFICATION
I HEREBY CERTIFY ON MY HONOR THAT ALL THE INFORMATION HEREIN CONTAINED IS TRUE AND CORRECT AND THAT I HAVE NOT ENROLLED IN ANY COURSE /SUBJECT BEYOND HIGH SCHOOL, OTHERWISE MY APPLICATION FOR ENTRANCE IN BICOL UNIVERSITY WILL BE RENDERED INVALID.

Signature of Applicant

Signature of Parent/Guardian over Printed Name

NOTE: Please submit worth P40.00 of stamps and (1) long window envelope, for mailing your BUCET Result
IMPORTANT: PLEASE HAVE YOUR RATINGS ENTERED ON THE BACK SIDE OF THIS PAGE ; FOR THOSE WITH PEPT. SUBMIT A PHOTO COPY OF IT. FOR THOSE WHO HAVE GRADUATED IN PREVIOUS YEARS, SUBMIT PHOTOCOPY OF HS FORM 138. BU-F-ADMISSION-13C Effectivity: June, 2012 Rev. 1 Page 1 of 2

SECONDARY SCHOOL RECORD
TO THE PRINCIPAL: 1. 2. 3. 4. This form is an official document to be used by the BU Admissions Office for selective admission and research purposes. Please type or print legibly all information called for. Do not abbreviate. For the student’s name, print last name, first name and middle name in full. Be sure that all grades (i.e., including failing marks) are indicated and that all entries are complete and specific such as number of units or credits earned for such subject on this page. TAMPERING WILL INVALIDATE THIS APPLICATION FORM.

NAME OF STUDENT APPLICANT:

Last Name

First Name Public City/Province No. of Graduates/Expected Graduates

Middle Name Private

Name of High School

General Secondary

Vocational Secondary (Do not Abbreviate) District/Town

Address of High School Year of Graduation

SUBJECTS
FILIPINO ENGLISH MATHEMATICS SCIENCE MAKABAYAN • THE • PEHM • SOCIAL STUDIES • VALUES EDUCATION
OTHER ACADEMIC SUBJECTS NOT LISTED ABOVE

20

FIRST YEAR

to 20

20

SECONDYEAR

to 20

20

THIRD YEAR

to 20

Final Grades

Units

Final Grades

Units

Final Grades

Units

GENERAL WEIGHTED AVERAGE
(Please fill in the 3 boxes for year I to III)

This student belongs to the:

upper 10%

upper20%

upper40%

lower 50% of the graduating class

I HEREBY CERTIFY AS TO THE COMPLETENESS AND CORRECTNESS OF THE FOREGOING RECORD AND FURTHER ATTEST THAT___________________________________________________.
(Fill-in applicant’s name)

PRINCIPAL’S CERTIFICATION

will be graduating in high school this school year 20 - 20

has graduated in high school during the school year . Form 137-A requested by:

*check () appropriate box
Affix school dry seal here, if school has one.

Name of School Principal’s Signature (in ink) Principal’s Name (Print)
(Facsimile not allowed)

Date
BU-F-ADMISSION-13C Effectivity: June, 2012 Rev. 1 Page 2 of 2