OSAS- QF- 01

Republic of the Philippines ENTRY:

CAVITE STATE UNIVERSITY ____New Student
____Transferee 1x1
Don Severino delas Alas Campus ____ 2nd courser
ID Picture
____ from Branch Campus:
Indang, Cavite
(______________)
APPLICATION FORM FOR ADMISSION
EXAM CONTROL NO: ______________________
Please Indicate Preferred Courses:

1st choice 2nd choice 3rd choice

Learner’s Reference Number:  STRAND(SHS Grad): _____________

Name:
____________________________________________________________________________________
Last Name First Name Middle Name
Permanent Address: __________________________________________________________________
_______________________________________________________________Zip Code: ____________
Contact number: _________________________ Email Address: ________________________________
Sex: M F Age:_______ Date of Birth:___________________ Religion: ____________________
Nationality: ____________________ Civil Status: Single Married Others, specify: ____________

FAMILY BACKGROUND
Father Mother Guardian____________________
(Specify relationship)
Full Name: _____________________ ______________________ ___________________________
Contact no: _____________________ ______________________ ___________________________
Occupation: _____________________ ______________________ ___________________________
Number of Sibling/s: ______ Birth Order: Eldest Second Middle Youngest Only Child
Estimated Monthly Family Income: (Please tick the appropriate box)
below -10,000 11,000 – 20,000 21,000 – 30,000 31,000 – 40,000 41,000– 50,000 above 50,000
EDUCATIONAL BACKGROUND
Name of School Address Year Graduated
Elementary ______________________ ______________________ ______________
Senior High School ______________________ ______________________ ______________
Vocational ______________________ ______________________ ______________
College - For Transferees: _________________ ______________________ Course: ____________
For Second Courser: _________________ ______________________ Course: ____________
MEDICAL HISTORY INFORMATION
List any medications you are taking: ________________
Do you have any of the following? Kindly put a check (✓) To be filled up by the OSAS/Guidance Staff
Allergy (specifically, allergic to: __________________) Date of Exam and time: ______________________
Asthma SUBMITTED REQUIREMENTS
Hypertension
Diabetes □ 2 copies of 1x1 ID Picture
Insomnia □ Short ordinary white folder
New Student (SHS, ALS, BEC graduate)
Vertigo □ Photocopy HS or SHS Form138 / Certificate of ALS
Scoliosis or physical condition, specify: __________ Rating
Others, please specify: _______________________ □ Photocopy Certificate of Good Moral Character
None Transferee / Second Degree taker
□ Photocopy Transcript of Records / Certificate of Grades
□ Photocopy Transfer Credentials / Honorable Dismissal
I hereby attest that all information stated above is true and correct. □ Photocopy Certificate of Good Moral Character
□ Photocopy NBI Clearance
______________________________ □ Photocopy Interview slip
Second Degree taker
Signature over printed name □ Photocopy Transcript of Records
□ Interview slip
Assessed by: ________________

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 PLEASE ATTACH THE FOLLOWING REQUIREMENTS ON THIS APPLICATION
FORM:
FILIPINO APPLICANTS
MUST: All requirements shall be placed in a short ordinary FOLDER.

Grade 12 Graduate /HIGH SCHOOL GRADUATE:

1. Photocopy of High School Report Card
2. Photocopy of Certification of Good Moral Character
3. Two copies of 1x1 ID Picture
TRANSFEREES: Process Flow for Transferees:
1. Photocopy of TOR or Certification of grades signed by the Registrar 1. Submit all these
2. Photocopy of Honorable Dismissal or Transfer Credentials requirements to Guidance
3. Photocopy of Certification of Good Moral Character
Office and have it checked
by the guidance staff.
4. Photocopy of NBI Clearance(for students who are 18 years old & above) 2. After getting the Notice for
or Police Clearance (if the student is 17 years old and below) interview form from the
Guidance, proceed to
5. Two copies of 1x1 ID Picture
College for
If the applicant* is from the other CvSU Branch Campuses: interview/evaluation.
* No need to take entrance exam, unless special condition 3. If passed, photocopy the
Requirements - form. If failed, go back to
1. Photocopy of TOR or Certification of grades signed by the Registrar Guidance Office.
4. After passing the College
2. Photocopy of Honorable Dismissal or Transfer Credentials interview, student may now
3. Photocopy of Certification of Good Moral Character take exam
4. Two copies of 1x1 ID Picture

SECOND COURSER:
1. Photocopy of TOR or Certification of grades signed by the Registrar
2. Two copies of 1x1 ID Picture

FOREIGN APPLICANTS
Process Flow for Foreign
1. Approved permit to study from the concerned embassy Applicants:
2. Report Card or Transcript of Records from High School last attended
1. Foreign applicants must
3. Police Clearance Certificate issued by the National Police Authorities
proceed first to the
from the applicant’s country of origin or/and NBI Clearance Registrar’s Office for initial
4. Affidavit of financial support duly authenticated by evaluation of requirements.
2. Registrar office shall issue a
the Philippine Foreign Service Post
simple note that they have
5. Certificate of English Proficiency (as necessary) checked their requirements
6. Photocopy of Certification of Good Moral Character and allow the Guidance office
to process the applicant’s
7. Two pieces 1x1 ID Picture examination

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