Republic of the Philippines

Southern Luzon State University

STUDENT ADMISSION COMMITTEE 2” x 2”
1st Floor, MIS-ICT Building Photo with nametag
Lucban, Quezon
Application Date

APPLICATION FOR COLLEGE ENTRANCE EXAMINATION

Instructions:
1. Fill out application form and secure 2 pieces 2” x 2” colored ID picture with nametag.
2. Proceed to the nearest SLSU Campus at your place.
3. Submit the following documents:
a. Application Form
b. For Grade 12 student expected to graduate at the end of Academic Year 2019-2020, photocopy of Grade 11 Report Card (back-to-back)
c. For Transferee student, photocopy of Transcript of Records (TOR) or General Certificate of Secondary Education (for applicants based abroad)
d. Photocopy of Certificate of Income of Parents (MSWD Certification for Pantawid Pamilyang Pilipino Program (4Ps)/Indigenous People (IPs)
members, ITR, BIR Tax-exemption, or OEC/Employment Contract for OFWs)
4. Secure your examination permit from the campus where you passed your application or through your registered Gmail account.
5. Take the SLSU Electronic College Entrance Examination on the scheduled date, time, and venue as indicated on the Test Permit. All applicants
must bring the Test Permit and Student ID (or equivalent valid ID) on the testing day. Guidelines and reminders stated on the test permit must
be strictly followed.
6. Access the test result from the SLSU website at http://slsu.edu.ph on March 2020.

PERSONAL INFORMATION
Last Name: First Name: Middle Name:

Date of Birth: Place of Birth: Civil Status:

Age: Sex: Male Nationality: Religion:

Female
COMPLETE MAILING ADDRESS
No./Street Name: Barangay:

Town Province: Postal Code:

Tel. No.: Mobile No.

Valid Email Address (Gmail):

SOCIO-ECOMIC STATUS
Father’s Full Name: Occupation:

Annual Income of Father: below 200,000 201,000-400,000 above 400,000 4Ps/IPs: Yes No
Mother’s Full Name: Occupation:

Annual Income of Mother: below 200,000 201,000-400,000 above 400,000 4Ps/IPs: Yes No
No. of Siblings below 21 years old: Living with Parents? Yes No
SENIOR HIGH SCHOOL INFORMATION/ LAST SCHOOL ATTENDED
Name of School:

School Address:

Type of School: Public Private-Sectarian Private-Non Sectarian Others, pls. specify __________________________

Learner Reference Number (LRN):

SLSU CAMPUS APPLIED FOR: (Please refer to the list of campuses and courses)
First Choice Campus: 1st Choice Course:

2nd Choice Course:

Second Choice Campus: 1st Choice Course:

2nd Choice Course:

PREFERRED TESTING CENTER (Select only one)

SLSU Main SLSU Catanauan SLSU Gumaca SLSU Infanta SLSU Tagkawayan
Do you have any PHYSICAL DISABILITY OR CONDITION that requires Signature of Applicant:
special attention or would make it difficult for you to take regular test?

NO YES (pls. specify)

Assessed by: Date:

_______________________________________
(Signature over Printed Name)