O.R. No.

: __________________ Repuplic of the Philippines

Southern Luzon State University ______________________
Date: __________________ GUIDANCE, COUNSELING & TESTING CENTER Control No.
Lucban, Quezon

APPLICATION FOR COLLEGE ENTRANCE EXAMINATION

(To be filled up by SLSU Guidance Personnel)  SLSU Main Campus
 SLSU Gumaca  SLSU Polillo
 CBA Bldg.
 SLSU Infanta  SLSU Tagkawayan
 SLSU Alabat
Date of Exam: ________________________________ Time: _______________  SLSU Lucena  SLSU Tiaong
 SLSU Catanauan

TO THE STUDENT AND PARENT/GUARDIAN

Read carefully the GENERAL INFORMATION BULLETIN ON FRESHMAN ADMISSION before filling out this application form.
Print legibly all information required. Place X marks in appropriate boxes.

1. APPLICANT’S NAME:

Print or type your full name in the following sequence: LAST NAME, FIRST NAME, MIDDLE NAME. Place one letter in each box. Leave one box blank between names.

LAST

FIRST
Staple or paste a recent 2”
MIDDLE x 2” photograph with
2. SEX Male Female white background (taken
within the last six months)
3. DATE OF BIRTH (Month, Day, Year)
in this box.
4. PLACE OF BIRTH (City/Town, Province)
Be sure to print your name
5. CIVIL STATUS Single Married Widow/Widower at the back of the photo.

6. CITIZENSHIP

7. CONTACT INFORMATION:
Permanent Home Address: _______________________________________________________________________________________
Telephone/Cellphone No. (if any): _______________________________________________________________________________________
Email – Address: _______________________________________________________________________________________

8. HIGH SCHOOL (where you completed/are completing secondary level education):

High School Name (Do not Abbreviate) Month/Year of Completion

Address (City/Town, Province)

TYPE OF HIGH SCHOOL: Public Private-Sectarian Private - Non Sectarian

Others, Pls. Specify

9. SLSU CAMPUS APPLIED FOR: Choose from among the following, write your choice on the space below (up to two choices allowed)
1. SLSU Main 3. SLSU Catanauan 5. SLSU Infanta 7. SLSU Polillo
2. SLSU Alabat 4. SLSU Gumaca 6. SLSU Lucena Dual Tech 8. SLSU JGE-Tagkawayan 9. SLSU Tiaong

Do not indicate the same campus twice. Make sure that course choices are offered in the campus indicated. Write NONE on the blank if you do not have other
choices of campus/course. Please see back page of the paper for the course code.

SLSU CAMPUS INTENDED COURSE COURSE CODE

1st Choice
1st Choice
2nd Choice

1st Choice
2nd Choice
2nd Choice

10. SLSU Testing Centers

Choose your preferred SLSU Testing Center
 SLSU Main Campus – Lucban Quezon  SLSU Lucena Campus
 SLSU Alabat Campus  SLSU Polillo Campus
 SLSU Catanauan Campus  SLSU Tagkawayan Campus
 SLSU Gumaca Campus  SLSU Tiaong Campus
 SLSU Infanta

 SLSU2Infanta Camp
AA-INS-2.01F1, Revision
 11. ARE YOU A CHILD OF SLSU FACULTY OR EMPLOYEE? NO YES
IF YES Name of parent employed in SLSU Official Designation College/Unit where employed

A. Category B. Tenure C. Status (Place an X in only one box)

 Full – time  Permanent  In active service
 Part – time  Temporary  On leave with pay
 Casual  On leave without pay
 Contractual

12. Do you have any PHYSICAL DISABILITY OR CONDITION that requires special attention or would make it difficult for you to take a regular test

No Yes (specify) _____________________________________

to be filled up by SLSU Guidance Personnel FOR TRANSFEREES ONLY

HIGH SCHOOL GRADES COLLEGE/UNIVERSITY LAST ATTENDED:

FINAL GRADE 1st 2nd 3rd

ENGLISH
MATH Reason for transfer: Approved:
SCIENCE
GEN. AVERAGE College Dean

I affirm that:

1) I have read all the information contained in the General Information Bulletin on Freshman
Admission and understood all the instructions relative to my application for the SLSU Admission
Exam;
I certify that all information declared here are true and
2) All the information supplied in this application form are true, complete and accurate;
3) I have not taken the SLSU CEE previously correct
4) I will abide by the University rules and policies on test administration

I am aware that every information written in this application may be checked against the original
documents and I understand that I will be allowed to take the examination upon submission of complete
requirements.
Signature over Printed Name of Parent/Guardian
Furthermore, I understand that all information I provide in this form as well as during the Admission
Exam may be used by the University for research and I believe that my personal details will be treated
with utmost confidentiality.
Date

Signature over Printed Name of Student

Date

XXX-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------XXX

O.R. No.___________________________________________________ Date _____________________________________________ Control No. ________________________________________________

APPLICATION RECEIPT
SLSU CAMPUS COURSE CODE Staple or paste a recent
(Please copy the correct course code)
2” x 2” photograph
1st Choice with white background
1st Choice (taken within the last
2nd Choice six months) in this box.

1st Choice Be sure to print your

2nd Choice name at the back of the
2nd Choice photo.

APPLICANT NAME ________________________________________________________________ GENDER _____________________________

DATE OF BIRTH ________________________________________________________________ PLACE OF BIRTH ______________________________

SIGNATURE: ________________________________________________________________ DATE: ______________________________

SCHEDULE OF EXAM (to be filled up by Guidance Personnel) Admission Requirements: Bring the following on examination day:

DATE: ____________________________________________ TIME: ___________________________ 1. Application Receipt

1. 2 (two) pcs. 2”x2” with white
SLSU Testing Center: 2. Pencil 2pcs. (Mongol No. 2)
background (recent photo) 3. Eraser
 SLSU Main Campus – Lucban Quezon 2. High School Form 137
 SLSU Gumaca Guidance Office: 4. School ID
 CBA Bldg. (042) 540 – 4087 (Grades from 1st year to 3rd
 SLSU Lucena Loc. No. 135/
 SLSU Alabat  FAILURE OF APPEARANCE TO THE
 SLSU Polillo (042) 540 – 3949 year H.S.) (Clear Xerox
 SLSU Catanauan SPECIFIED DATE MEANS NO
www.slsu.edu.ph Copy)
 SLSU Tagkawayan RECONSIDERATION FOR RE – SCHEDULING
 SLSU Infanta
 SLSU Tiaong 3. Examination Fee Php 150.00  LATE COMERS WILL NOT BE ENTERTAINED

AA-INS-2.01F1, Revision 2